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Yuan J, He R, Alkhateeb HB. Sporadic and Familial Acute Myeloid Leukemia with CEBPA Mutations. Curr Hematol Malig Rep 2023; 18:121-129. [PMID: 37261703 PMCID: PMC10484814 DOI: 10.1007/s11899-023-00699-3] [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] [Accepted: 05/14/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE OF REVIEW CCAAT enhancer binding protein A (CEBPA) gene mutation is one of the common genetic alterations in acute myeloid leukemia (AML), which can be associated with sporadic and familial AML. RECENT FINDINGS Due to the recent advances in molecular testing and the prognostic role of CEBPA mutation in AML, the definition for AML with CEBPA mutation (AML-CEBPA) has significantly changed. This review provides the rationale for the updates on classifications, and the impacts on laboratory evaluation and clinical management for sporadic and familial AML-CEBPA patients. In addition, minimal residual disease assessment post therapy to stratify disease risk and stem cell transplant in selected AML-CEBPA patients are discussed. Taken together, the recent progresses have shifted the definition, identification, and management of patients with AML-CEBPA.
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Affiliation(s)
- Ji Yuan
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN USA
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2
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Bi L, Ma T, Li X, Wei L, Liu Z, Feng B, Dong B, Chen X. New progress in the study of germline susceptibility genes of myeloid neoplasms. Oncol Lett 2021; 21:317. [PMID: 33692849 PMCID: PMC7933751 DOI: 10.3892/ol.2021.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/21/2021] [Indexed: 12/25/2022] Open
Abstract
In 2016, the World Health Organization incorporated ‘myeloid neoplasms with germline predisposition’ into its classification of tumors of hematopoietic and lymphoid tissues, revealing the important role of germline mutations in certain myeloid neoplasms, particularly myelodysplastic syndrome and acute myeloid leukemia. The awareness of germline susceptibility has increased, and some patients with myeloid neoplasms present with a preexisting disorder or organ dysfunction. In such cases, mutations in genes including CCAAT enhancer binding protein α (CEBPA), DEAD (Asp-Glu-Ala-Asp) box polypeptide 41 (DDX41), RUNX family transcription factor 1 (RUNX1), GATA binding protein 2 (GATA2), Janus kinase 2 (JAK2) and ETS variant transcription factor 6 (ETV6) have been recognized. Moreover, with the application of advanced technologies and reports of more cases, additional germline mutations associated with myeloid neoplasms have been identified and provide insights into the formation, prognosis and therapy of myeloid neoplasms. The present review discusses the well-known CEBPA, DDX41, RUNX1, GATA2, JAK2 and ETV6 germline mutations, and other mutations including those of lymphocyte adapter protein/SH2B adapter protein 3 and duplications of autophagy related 2B, GSK3B interacting protein αnd RB binding protein 6, ubiquitin ligase, that remain to be confirmed or explored. Recommendations for the management of diseases associated with germline mutations are also provided.
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Affiliation(s)
- Lei Bi
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Tianyuan Ma
- Department of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xu Li
- College of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Lai Wei
- College of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zinuo Liu
- College of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Bingyue Feng
- College of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Baoxia Dong
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiequn Chen
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.,Hematology and Oncology Center, Affiliated Hospital of Northwest University and Xian No. 3 Hospital, Xi'an, Shaanxi 710082, P.R. China
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3
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Brown AL, Hahn CN, Scott HS. Secondary leukemia in patients with germline transcription factor mutations (RUNX1, GATA2, CEBPA). Blood 2020; 136:24-35. [PMID: 32430494 PMCID: PMC7332898 DOI: 10.1182/blood.2019000937] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
Recognition that germline mutations can predispose individuals to blood cancers, often presenting as secondary leukemias, has largely been driven in the last 20 years by studies of families with inherited mutations in the myeloid transcription factors (TFs) RUNX1, GATA2, and CEBPA. As a result, in 2016, classification of myeloid neoplasms with germline predisposition for each of these and other genes was added to the World Health Organization guidelines. The incidence of germline mutation carriers in the general population or in various clinically presenting patient groups remains poorly defined for reasons including that somatic mutations in these genes are common in blood cancers, and our ability to distinguish germline (inherited or de novo) and somatic mutations is often limited by the laboratory analyses. Knowledge of the regulation of these TFs and their mutant alleles, their interaction with other genes and proteins and the environment, and how these alter the clinical presentation of patients and their leukemias is also incomplete. Outstanding questions that remain for patients with these germline mutations or their treating clinicians include: What is the natural course of the disease? What other symptoms may I develop and when? Can you predict them? Can I prevent them? and What is the best treatment? The resolution of many of the remaining clinical and biological questions and effective evidence-based treatment of patients with these inherited mutations will depend on worldwide partnerships among patients, clinicians, diagnosticians, and researchers to aggregate sufficient longitudinal clinical and laboratory data and integrate these data with model systems.
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MESH Headings
- Age of Onset
- Blood Cell Count
- CCAAT-Enhancer-Binding Proteins/genetics
- Core Binding Factor Alpha 2 Subunit/genetics
- Disease Management
- Early Detection of Cancer
- Forecasting
- GATA2 Transcription Factor/genetics
- Genes, Neoplasm
- Genetic Counseling
- Genetic Predisposition to Disease
- Germ-Line Mutation
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Myelodysplastic Syndromes/genetics
- Neoplasms, Second Primary/genetics
- Penetrance
- Prognosis
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Affiliation(s)
- Anna L Brown
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; and
| | - Christopher N Hahn
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; and
| | - Hamish S Scott
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; and
- ACRF Cancer Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
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Schratz KE, DeZern AE. Genetic Predisposition to Myelodysplastic Syndrome in Clinical Practice. Hematol Oncol Clin North Am 2020; 34:333-356. [PMID: 32089214 PMCID: PMC7875473 DOI: 10.1016/j.hoc.2019.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Myelodysplastic syndromes (MDSs) are a heterogeneous group of marrow failure disorders that primarily affect older persons but also occur at a lower frequency in children and young adults. There is increasing recognition of an inherited predisposition to MDS as well as other myeloid malignancies for patients of all ages. Germline predisposition to MDS can occur as part of a syndrome or sporadic disease. The timely diagnosis of an underlying genetic predisposition in the setting of MDS is important. This article delineates germline genetic causes of MDS and provides a scaffold for the diagnosis and management of patients in this context.
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Affiliation(s)
- Kristen E Schratz
- Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Bloomberg 11379, 1800 Orleans Street, Baltimore, MD 21287, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, Baltimore, MD 21287, USA
| | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, Baltimore, MD 21287, USA; Division of Hematologic Malignancies, Johns Hopkins University School of Medicine, CRBI Room 3M87, 1650 Orleans Street, Baltimore, MD 21287-0013, USA.
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Ng IKS, Lee J, Ng C, Kosmo B, Chiu L, Seah E, Mok MMH, Tan K, Osato M, Chng WJ, Yan B, Tan LK. Preleukemic and second-hit mutational events in an acute myeloid leukemia patient with a novel germline RUNX1 mutation. Biomark Res 2018; 6:16. [PMID: 29780592 PMCID: PMC5948813 DOI: 10.1186/s40364-018-0130-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/30/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Germline mutations in the RUNX1 transcription factor give rise to a rare autosomal dominant genetic condition classified under the entity: Familial Platelet Disorders with predisposition to Acute Myeloid Leukaemia (FPD/AML). While several studies have identified a myriad of germline RUNX1 mutations implicated in this disorder, second-hit mutational events are necessary for patients with hereditary thrombocytopenia to develop full-blown AML. The molecular picture behind this process remains unclear. We describe a patient of Malay descent with an unreported 7-bp germline RUNX1 frameshift deletion, who developed second-hit mutations that could have brought about the leukaemic transformation from a pre-leukaemic state. These mutations were charted through the course of the treatment and stem cell transplant, showing a clear correlation between her clinical presentation and the mutations present. CASE PRESENTATION The patient was a 27-year-old Malay woman who presented with AML on the background of hereditary thrombocytopenia affecting her father and 3 brothers. Initial molecular testing revealed the same novel RUNX1 mutation in all 5 individuals. The patient received standard induction, consolidation chemotherapy, and a haploidentical stem cell transplant from her mother with normal RUNX1 profile. Comprehensive genomic analyses were performed at diagnosis, post-chemotherapy and post-transplant. A total of 8 mutations (RUNX1, GATA2, DNMT3A, BCORL1, BCOR, 2 PHF6 and CDKN2A) were identified in the pre-induction sample, of which 5 remained (RUNX1, DNMT3A, BCORL1, BCOR and 1 out of 2 PHF6) in the post-treatment sample and none were present post-transplant. In brief, the 3 mutations which were lost along with the leukemic cells at complete morphological remission were most likely acquired leukemic driver mutations that were responsible for the AML transformation from a pre-leukemic germline RUNX1-mutated state. On the contrary, the 5 mutations that persisted post-treatment, including the germline RUNX1 mutation, were likely to be part of the preleukemic clone. CONCLUSION Further studies are necessary to assess the prevalence of these preleukemic and secondary mutations in the larger FPD/AML patient cohort and establish their prognostic significance. Given the molecular heterogeneity of FPD/AML and other AML subtypes, a better understanding of mutational classes and their involvement in AML pathogenesis can improve risk stratification of patients for more effective and targeted therapy.
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Affiliation(s)
- Isaac KS Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Joanne Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228 Singapore
| | - Christopher Ng
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Bustamin Kosmo
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Lily Chiu
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Elaine Seah
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228 Singapore
| | - Michelle Meng Huang Mok
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore, 117599 Singapore
| | - Karen Tan
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Motomi Osato
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore, 117599 Singapore
- International Research Center for Medical Sciences, Kumamoto University, 2-2-1 Honjo, Chuo-ku, Kumamoto City, 860-0811 Japan
- Institute of Bioengineering and Nanotechnology, A*STAR, 31 Biopolis Way, Singapore, 138669 Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 12, Singapore, 119228 Singapore
| | - Wee-Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228 Singapore
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore, 117599 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228 Singapore
| | - Benedict Yan
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Lip Kun Tan
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228 Singapore
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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Gao J, Gong S, Chen YH. Myeloid Neoplasm With Germline Predisposition: A 2016 Update for Pathologists. Arch Pathol Lab Med 2018; 143:13-22. [PMID: 29372845 DOI: 10.5858/arpa.2017-0194-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Myeloid neoplasms with familial occurrence have been rarely reported in the past. With the advance of molecular technology and better understanding of the molecular pathogenesis of myeloid neoplasms, investigating the genetic causes of familial acute myeloid leukemia or myelodysplastic syndrome has become feasible in the clinical setting. Recent studies have identified a rapidly expanding list of germline mutations associated with increased risks of developing myeloid neoplasm in the affected families. It is important to recognize these entities, as such a diagnosis may dictate a unique approach in clinical management and surveillance for the patients and carriers. OBJECTIVE.— To raise the awareness of myeloid neoplasms arising in the setting of familial inheritance among practicing pathologists. DATA SOURCES.— Based on recent literature and the 2016 revision of the World Health Organization classification of hematopoietic neoplasms, we provide an up-to-date review of myeloid neoplasm with germline predisposition. CONCLUSIONS.— This short review focuses on the clinical, pathologic, and molecular characterization of myeloid neoplasm with germline predisposition. We emphasize the important features that will help practicing pathologists to recognize these newly described entities.
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Affiliation(s)
- Juehua Gao
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shunyou Gong
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yi-Hua Chen
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ng IK, Ng C, Low JJ, Chiu L, Seah E, Ng CH, Chng WJ, Yan B, Ban KHK. Identifying large indels in targeted next generation sequencing assays for myeloid neoplasms: a cautionary tale of the ZRSR1 pseudogene. J Clin Pathol 2017; 70:1069-1073. [PMID: 28676493 DOI: 10.1136/jclinpath-2017-204440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 11/04/2022]
Abstract
Targeted next generation sequencing platforms have been increasingly utilised for identification of novel mutations in myeloid neoplasms, such as acute myeloid leukaemia (AML), and hold great promise for use in routine clinical diagnostics. In this study, we evaluated the utility of an open source variant caller in detecting large indels in a targeted sequencing of AML samples. While we found that this bioinformatics pipeline has the potential to accurately capture large indels (>20 bp) in patient samples, we highlighted the pitfall of a confounding ZRSR1 pseudogene that led to an erroneous ZRSR2 variant call. We further discuss possible clinical implications of the ZRSR1 pseudogene in myeloid neoplasms based on its molecular features. Knowledge of the confounding ZRSR1 pseudogene in ZRSR2 sequencing assays could be particularly important in AML diagnostics because the detection of ZRSR2 in AML patients is highly specific for an s-AML diagnosis.
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Affiliation(s)
- Isaac Ks Ng
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Ng
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore
| | - Jia Jin Low
- Department of Statistics, National University of Singapore, Singapore
| | - Lily Chiu
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore
| | - Elaine Seah
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Chin Hin Ng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Wee-Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute, National University of Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore
| | - Kenneth H K Ban
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Yan B, Hu Y, Ban KHK, Tiang Z, Ng C, Lee J, Tan W, Chiu L, Tan TW, Seah E, Ng CH, Chng WJ, Foo R. Single-cell genomic profiling of acute myeloid leukemia for clinical use: A pilot study. Oncol Lett 2017; 13:1625-1630. [PMID: 28454300 PMCID: PMC5403273 DOI: 10.3892/ol.2017.5669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 11/21/2016] [Indexed: 02/03/2023] Open
Abstract
Although bulk high-throughput genomic profiling studies have led to a significant increase in the understanding of cancer biology, there is increasing awareness that bulk profiling approaches do not completely elucidate tumor heterogeneity. Single-cell genomic profiling enables the distinction of tumor heterogeneity, and may improve clinical diagnosis through the identification and characterization of putative subclonal populations. In the present study, the challenges associated with a single-cell genomics profiling workflow for clinical diagnostics were investigated. Single-cell RNA-sequencing (RNA-seq) was performed on 20 cells from an acute myeloid leukemia bone marrow sample. Putative blasts were identified based on their gene expression profiles and principal component analysis was performed to identify outlier cells. Variant calling was performed on the single-cell RNA-seq data. The present pilot study demonstrates a proof of concept for clinical single-cell genomic profiling. The recognized limitations include significant stochastic RNA loss and the relatively low throughput of the current proposed platform. Although the results of the present study are promising, further technological advances and protocol optimization are necessary for single-cell genomic profiling to be clinically viable.
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Affiliation(s)
- Benedict Yan
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore 119228, Republic of Singapore
| | - Yongli Hu
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore 138632, Republic of Singapore
| | - Kenneth H K Ban
- Department of Biochemistry, National University of Singapore, Singapore 117596, Republic of Singapore
| | - Zenia Tiang
- Genome Institute of Singapore, Singapore 138672, Republic of Singapore.,Cardiovascular Research Institute, National University Health System, Singapore 119228, Republic of Singapore
| | - Christopher Ng
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore 119228, Republic of Singapore
| | - Joanne Lee
- Department of Hematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119228, Republic of Singapore
| | - Wilson Tan
- Genome Institute of Singapore, Singapore 138672, Republic of Singapore
| | - Lily Chiu
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore 119228, Republic of Singapore
| | - Tin Wee Tan
- National Supercomputing Centre, Singapore 138632, Republic of Singapore
| | - Elaine Seah
- Department of Hematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119228, Republic of Singapore
| | - Chin Hin Ng
- Department of Hematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119228, Republic of Singapore
| | - Wee-Joo Chng
- Department of Hematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119228, Republic of Singapore.,Cancer Science Institute, National University of Singapore, Singapore 117599, Republic of Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Republic of Singapore
| | - Roger Foo
- Genome Institute of Singapore, Singapore 138672, Republic of Singapore.,Cardiovascular Research Institute, National University Health System, Singapore 119228, Republic of Singapore
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Tan M, Ng IKS, Chen Z, Ban K, Ng C, Chiu L, Seah E, Lin M, Tai BC, Yan B, Ng CH, Chng WJ. Clinical implications ofDNMT3Amutations in a Southeast Asian cohort of acute myeloid leukaemia patients. J Clin Pathol 2017; 70:669-676. [DOI: 10.1136/jclinpath-2016-204195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 02/03/2023]
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