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Chatzikalil E, Roka K, Diamantopoulos PT, Rigatou E, Avgerinou G, Kattamis A, Solomou EE. Venetoclax Combination Treatment of Acute Myeloid Leukemia in Adolescents and Young Adult Patients. J Clin Med 2024; 13:2046. [PMID: 38610812 PMCID: PMC11012941 DOI: 10.3390/jcm13072046] [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: 02/24/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Over the past two decades, the prognosis in adolescents and young adults (AYAs) diagnosed with acute myeloid leukemia (AML) has significantly improved. The standard intensive cytotoxic treatment approach for AYAs with AML, consisting of induction chemotherapy with anthracycline/cytarabine combination followed by consolidation chemotherapy or stem cell transplantation, has lately been shifting toward novel targeted therapies, mostly in the fields of clinical trials. One of the most recent advances in treating AML is the combination of the B-cell lymphoma 2 (Bcl-2) inhibitor venetoclax with hypomethylating agents, which has been studied in elderly populations and was approved by the Food and Drug Administration (FDA) for patients over 75 years of age or patients excluded from intensive chemotherapy induction schemas due to comorbidities. Regarding the AYA population, venetoclax combination therapy could be a therapeutic option for patients with refractory/relapsed (R/R) AML, although data from real-world studies are currently limited. Venetoclax is frequently used by AYAs diagnosed with advanced hematologic malignancies, mainly acute lymphoblastic leukemia and myelodysplastic syndromes, as a salvage therapeutic option with considerable efficacy and safety. Herein, we aim to summarize the evidence obtained from clinical trials and observational studies on venetoclax use in AYAs with AML. Based on the available evidence, venetoclax is a safe and effective therapeutic option for R/R AML AYA patients. However, further research in larger cohorts is needed to confirm these data, establishing the benefits of a venetoclax-based regimen for this special population.
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Affiliation(s)
- Elena Chatzikalil
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (E.C.); (K.R.); (E.R.); (G.A.); (A.K.)
- “Aghia Sofia” Children’s Hospital ERN-PeadCan Center, 11527 Athens, Greece
| | - Kleoniki Roka
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (E.C.); (K.R.); (E.R.); (G.A.); (A.K.)
- “Aghia Sofia” Children’s Hospital ERN-PeadCan Center, 11527 Athens, Greece
| | - Panagiotis T. Diamantopoulos
- First Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Efthymia Rigatou
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (E.C.); (K.R.); (E.R.); (G.A.); (A.K.)
- “Aghia Sofia” Children’s Hospital ERN-PeadCan Center, 11527 Athens, Greece
| | - Georgia Avgerinou
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (E.C.); (K.R.); (E.R.); (G.A.); (A.K.)
- “Aghia Sofia” Children’s Hospital ERN-PeadCan Center, 11527 Athens, Greece
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (E.C.); (K.R.); (E.R.); (G.A.); (A.K.)
- “Aghia Sofia” Children’s Hospital ERN-PeadCan Center, 11527 Athens, Greece
| | - Elena E. Solomou
- Department of Internal Medicine, University of Patras Medical School, 26500 Rion, Greece
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Czogała M, Czogała W, Pawińska-Wąsikowska K, Książek T, Bukowska-Strakova K, Sikorska-Fic B, Łaguna P, Fałkowska A, Drabko K, Muszyńska-Rosłan K, Krawczuk-Rybak M, Kozłowska M, Irga-Jaworska N, Zielezińska K, Urasiński T, Bartoszewicz N, Styczyński J, Skalska-Sadowska J, Wachowiak J, Rodziewicz-Konarska A, Kałwak K, Ciebiera M, Chaber R, Mizia-Malarz A, Chodała-Grzywacz A, Karolczyk G, Bobeff K, Młynarski W, Mycko K, Badowska W, Tomaszewska R, Szczepański T, Machnik K, Zamorska N, Balwierz W, Skoczeń S. Characteristics and Outcome of FLT3-ITD-Positive Pediatric Acute Myeloid Leukemia-Experience of Polish Pediatric Leukemia and Lymphoma Study Group from 2005 to 2022. Cancers (Basel) 2023; 15:4557. [PMID: 37760526 PMCID: PMC10526903 DOI: 10.3390/cancers15184557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The FMS-like tyrosine kinase 3 (FLT3) gene mutated in 10-15% of pediatric acute myeloid leukemia (AML) is associated with an inferior outcome. The aim of the study was to analyze the outcome and characteristics of FLT3-ITD-positive pediatric AML. METHODS We retrospectively analyzed the nationwide pediatric AML database from between 2005 and 2022. FLT3-ITD was found in 54/497 (10.7%) patients with available analysis. Three consecutive treatment protocols were used (AML-BFM 2004 Interim, AML-BFM 2012 Registry, AML-BFM 2019 recommendations). RESULTS Probabilities of 5-year overall (OS), event-free (EFS) and relapse-free survival were significantly lower in the FLT3-ITD-positive patients compared to FLT3-ITD-negative (0.54 vs. 0.71, p = 0.041; 0.36 vs. 0.59, p = 0.0004; 0.47 vs. 0.70, p = 0.0029, accordingly). An improvement in the outcome was found in the analyzed period of time, with a trend of better survival in patients treated under the AML-BFM 2012 and AML-BFM 2019 protocols compared to the AML-BFM 2004 protocol (5-year EFS 0.52 vs. 0.27, p = 0.069). There was a trend of improved outcomes in patients treated with FLT3 inhibitors (n = 9, 2-year EFS 0.67 vs. 0.33, p = 0.053) and those who received stem cell transplantation (SCT) (n = 26; 5-year EFS 0.70 vs. 0.27, p = 0.059). The co-occurrence of the WT1 mutation had a dismal impact on the prognosis (5-year EFS 0.23 vs. 0.69, p = 0.002), while the NPM1 mutation improved survival (5-year OS 1.0 vs. 0.44, p = 0.036). CONCLUSIONS It seems that SCT and FLT3 inhibitors have a beneficial impact on the prognosis. Additional genetic alterations, like the WT1 and NPM1 mutations, significantly influence the outcome.
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Affiliation(s)
- Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Katarzyna Pawińska-Wąsikowska
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Teofila Książek
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
- Department of Medical Genetics, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Barbara Sikorska-Fic
- Department of Pediatrics, Oncology, Hematology and Transplantology, Medical University of Warsaw, 02-091 Warszawa, Poland; (B.S.-F.); (P.Ł.)
| | - Paweł Łaguna
- Department of Pediatrics, Oncology, Hematology and Transplantology, Medical University of Warsaw, 02-091 Warszawa, Poland; (B.S.-F.); (P.Ł.)
| | - Anna Fałkowska
- Department of Paediatric Haematology and Oncology and Transplantology, Medical University of Lublin, 20-095 Lublin, Poland; (A.F.); (K.D.)
| | - Katarzyna Drabko
- Department of Paediatric Haematology and Oncology and Transplantology, Medical University of Lublin, 20-095 Lublin, Poland; (A.F.); (K.D.)
| | - Katarzyna Muszyńska-Rosłan
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland; (K.M.-R.); (M.K.-R.)
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-089 Bialystok, Poland; (K.M.-R.); (M.K.-R.)
| | - Marta Kozłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.K.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.K.); (N.I.-J.)
| | - Karolina Zielezińska
- Department of Paediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (K.Z.); (T.U.)
| | - Tomasz Urasiński
- Department of Paediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland; (K.Z.); (T.U.)
| | - Natalia Bartoszewicz
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, 85-094 Bydgoszcz, Poland; (N.B.); (J.S.)
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, 85-094 Bydgoszcz, Poland; (N.B.); (J.S.)
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (J.S.-S.); (J.W.)
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (J.S.-S.); (J.W.)
| | - Anna Rodziewicz-Konarska
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (A.R.-K.); (K.K.)
| | - Krzysztof Kałwak
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (A.R.-K.); (K.K.)
| | - Małgorzata Ciebiera
- Clinic of Pediatric Oncology and Hematology, State Hospital 2, 35-301 Rzeszów, Poland; (M.C.); (R.C.)
| | - Radosław Chaber
- Clinic of Pediatric Oncology and Hematology, State Hospital 2, 35-301 Rzeszów, Poland; (M.C.); (R.C.)
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszów, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health Centre, 40-752 Katowice, Poland;
- Department of Pediatrics, Medical University of Silesia, Upper Silesia Children’s Care Health Centre, 40-752 Katowice, Poland
| | - Agnieszka Chodała-Grzywacz
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-736 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Grażyna Karolczyk
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-736 Kielce, Poland; (A.C.-G.); (G.K.)
| | - Katarzyna Bobeff
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland; (K.B.); (W.M.)
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland; (K.B.); (W.M.)
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, 10-561 Olsztyn, Poland; (K.M.); (W.B.)
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, 10-561 Olsztyn, Poland; (K.M.); (W.B.)
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (R.T.); (T.S.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (R.T.); (T.S.)
| | - Katarzyna Machnik
- Department of Pediatrics, Hematology and Oncology, City Hospital, 41-500 Chorzow, Poland;
| | - Natalia Zamorska
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland; (W.C.); (K.P.-W.); (W.B.); (S.S.)
- Department of Pediatric Oncology and Hematology, University Children Hospital, 30-683 Krakow, Poland;
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Bhatnagar B, Kohlschmidt J, Orwick SJ, Buelow DR, Fobare S, Oakes CC, Kolitz JE, Uy G, Stock W, Powell BL, Nicolet D, Hertlein EK, Mrózek K, Blachly JS, Eisfeld AK, Baker SD, Byrd JC. Framework of clonal mutations concurrent with WT1 mutations in adults with acute myeloid leukemia: Alliance for Clinical Trials in Oncology study. Blood Adv 2023; 7:4671-4675. [PMID: 37603350 PMCID: PMC10448419 DOI: 10.1182/bloodadvances.2023010482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Bhavana Bhatnagar
- Department of Hematology and Medical Oncology, West Virginia University Cancer Institute, Wheeling Hospital, Wheeling, WV
| | - Jessica Kohlschmidt
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | - Shelley J. Orwick
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Daelynn R. Buelow
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Sydney Fobare
- Department of Internal Medicine, Medical Student Training Program, College of Medicine, The Ohio State University, Columbus, OH
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher C. Oakes
- Clara D. Bloomfield Center, The Ohio State Comprehensive Cancer Center, Columbus, OH
| | | | - Geoff Uy
- Division of Oncology, Department of Medicine, Washington University, St. Louis, MO
| | - Wendy Stock
- Division of Hematology-Oncology, Department of Internal Medicine, University of Chicago, Chicago, IL
| | - Bayard L. Powell
- Division of Hematology-Oncology, Department of Internal Medicine, Wake Forest University Health System, Winston-Salem, NC
| | - Deedra Nicolet
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | - Erin K. Hertlein
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Krzysztof Mrózek
- Clara D. Bloomfield Center, The Ohio State Comprehensive Cancer Center, Columbus, OH
| | - James S. Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Ann-Kathrin Eisfeld
- Clara D. Bloomfield Center, The Ohio State Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Sharyn D. Baker
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - John C. Byrd
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
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Niktoreh N, Weber L, Walter C, Karimifard M, Hoffmeister LM, Breiter H, Thivakaran A, Soldierer M, Drexler HG, Schaal H, Sendker S, Reinhardt D, Schneider M, Hanenberg H. Understanding WT1 Alterations and Expression Profiles in Hematological Malignancies. Cancers (Basel) 2023; 15:3491. [PMID: 37444601 DOI: 10.3390/cancers15133491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
WT1 is a true chameleon, both acting as an oncogene and tumor suppressor. As its exact role in leukemogenesis is still ambiguous, research with model systems representing natural conditions surrounding the genetic alterations in WT1 is necessary. In a cohort of 59 leukemia/lymphoma cell lines, we showed aberrant expression for WT1 mRNA, which does not always translate into protein levels. We also analyzed the expression pattern of the four major WT1 protein isoforms in the cell lines and primary AML blasts with/without WT1 mutations and demonstrated that the presence of mutations does not influence these patterns. By introduction of key intronic and exonic sequences of WT1 into a lentiviral expression vector, we developed a unique tool that can stably overexpress the four WT1 isoforms at their naturally occurring tissue-dependent ratio. To develop better cellular model systems for WT1, we sequenced large parts of its gene locus and also other important myeloid risk factor genes and revealed previously unknown alterations. Functionally, inhibition of the nonsense-mediated mRNA decay machinery revealed that under natural conditions, the mutated WT1 alleles go through a robust degradation. These results offer new insights and model systems regarding the characteristics of WT1 in leukemia and lymphoma.
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Affiliation(s)
- Naghmeh Niktoreh
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Lisa Weber
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Christiane Walter
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Mahshad Karimifard
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Lina Marie Hoffmeister
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Hannah Breiter
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Aniththa Thivakaran
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Maren Soldierer
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Hans Günther Drexler
- Faculty of Life Sciences, Technical University of Braunschweig, 38106 Braunschweig, Germany
| | - Heiner Schaal
- Institute of Virology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Stephanie Sendker
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Dirk Reinhardt
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Markus Schneider
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Helmut Hanenberg
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany
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5
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Wang Y, Quesada AE, Zuo Z, Medeiros LJ, Yin CC, Li S, Xu J, Borthakur G, Li Y, Yang C, Abaza Y, Gao J, Lu X, You MJ, Zhang Y, Lin P. The Impact of Mutation of Myelodysplasia-Related Genes in De Novo Acute Myeloid Leukemia Carrying NPM1 Mutation. Cancers (Basel) 2022; 15:cancers15010198. [PMID: 36612194 PMCID: PMC9818485 DOI: 10.3390/cancers15010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background: The impact of gene mutations typically associated with myelodysplastic syndrome (MDS) in acute myeloid leukemia (AML) with NPM1 mutation is unclear. Methods: Using a cohort of 107 patients with NPM1-mutated AML treated with risk-adapted therapy, we compared survival outcomes of patients without MDS-related gene mutations (group A) with those carrying concurrent FLT3-ITD (group B) or with MDS-related gene mutations (group C). Minimal measurable disease (MMD) status assessed by multiparameter flow cytometry (MFC), polymerase chain reaction (PCR), and/or next-generation sequencing (NGS) were reviewed. Results: Among the 69 patients treated intensively, group C showed significantly inferior progression-free survival (PFS, p < 0.0001) but not overall survival (OS, p = 0.055) compared to group A. Though groups A and C had a similar MMD rate, group C patients had a higher relapse rate (p = 0.016). Relapse correlated with MMD status at the end of cycle 2 induction (p = 0.023). Survival of group C patients was similar to that of group B. Conclusion: MDS-related gene mutations are associated with an inferior survival in NPM1-mutated AML.
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Affiliation(s)
- Yi Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andres E. Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhuang Zuo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - C. Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chao Yang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yasmin Abaza
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Xinyan Lu
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - M. James You
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yizhuo Zhang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- Correspondence: (Y.Z.); (P.L.); Tel.: +86-18622221239 (Y.Z.); +1-(713)-794-1746 (P.L.); Fax: +86-022-23340123 (Y.Z.); +1-(713)-563-2977 (P.L.)
| | - Pei Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: (Y.Z.); (P.L.); Tel.: +86-18622221239 (Y.Z.); +1-(713)-794-1746 (P.L.); Fax: +86-022-23340123 (Y.Z.); +1-(713)-563-2977 (P.L.)
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6
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Meena JP, Pathak N, Gupta AK, Bakhshi S, Gupta R, Makkar H, Seth R. Molecular evaluation of gene mutation profiles and copy number variations in pediatric acute myeloid leukemia. Leuk Res 2022; 122:106954. [PMID: 36162216 DOI: 10.1016/j.leukres.2022.106954] [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: 05/23/2022] [Revised: 08/19/2022] [Accepted: 09/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objectives of this study were to investigate the mutation profiles of targeted genes and copy number variations (CNVs) in normal cytogenetics (CN) pediatric acute myeloid leukemia (AML). METHODS This prospective study was conducted from October 2018 to December 2020. The next-generation sequencing (NGS) and chromosomal microarray analyses (CMA) were performed in pediatric CN-AML patients. RESULTS Out of 94 children (aged ≤18 years), 70 patients with AML (24 excluded) underwent conventional karyotyping/cytogenetic analyses. Forty-five (64.3%) of patients had abnormal/ recurrent cytogenetic abnormalities and 25 (35.7%) had normal cytogenetics. Twenty-three out of 25 CN-AML were further processed for gene mutation profile and CNVs using NGS and CMA, respectively. Twenty-two out of 23 (95.7%) patients were detected to have mutations in various genes. The common mutations were: NRAS, NPM1, CEBPA, KRAS, KIT, RUNX1, NOTCH1, WT1, GATA1, GATA2, FLT3, KMT2D, FLT3-TKD, and PHF6. Copy number variations (CNVs) were detected in nine patients (39%), and eight (34.8%) had a long contiguous stretch of homozygosity (LCSH) /loss of heterozygosity (LOH). An LCSH was detected on chromosomes 5, 7, 11, and 19. The gains were more common than losses (8 vs 2). The gains were observed on chromosomes 8, 9, 14, 19, 21, and 22, and the losses were detected on chromosomes 7 and 10. Monosomy was observed in three patients. Three patients (monosomy7, n = 2, and FLT-ITD, n = 1) were reclassified into the high-risk category. Post-induction, complete remission was achieved in all evaluable patients. CONCLUSION CN-AML patients have genetic abnormalities that can be detected by more advanced techniques like NGS and CMA. These genetic abnormalities play a role in risk stratification that may remain hidden in otherwise CN-AML.
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Affiliation(s)
- Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Nivedita Pathak
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Ritu Gupta
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Harshita Makkar
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Rachna Seth
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
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7
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Li J, Liu L, Zhang R, Wan Y, Gong X, Zhang L, Yang W, Chen X, Zou Y, Chen Y, Guo Y, Ruan M, Zhu X. Development and validation of a prognostic scoring model to risk stratify childhood acute myeloid leukaemia. Br J Haematol 2022; 198:1041-1050. [PMID: 35880261 PMCID: PMC9543487 DOI: 10.1111/bjh.18354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
To create a personal prognostic model and modify the risk stratification of paediatric acute myeloid leukaemia, we downloaded the clinical data of 597 patients from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database as a training set and included 189 patients from our centre as a validation set. In the training set, age at diagnosis, -7/del(7q) or -5/del(5q), core binding factor fusion genes, FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD)/nucleophosmin 1 (NPM1) status, Wilms tumour 1 (WT1) mutation, biallelic CCAAT enhancer binding protein alpha (CEBPA) mutation were strongly correlated with overall survival and included to construct the model. The prognostic model demonstrated excellent discriminative ability with the Harrell's concordance index of 0.68, 3- and 5-year area under the receiver operating characteristic curve of 0.71 and 0.72 respectively. The model was validated in the validation set and outperformed existing prognostic systems. Additionally, patients were stratified into three risk groups (low, intermediate and high risk) with significantly distinct prognosis, and the model successfully identified candidates for haematopoietic stem cell transplantation. The newly developed prognostic model showed robust ability and utility in survival prediction and risk stratification, which could be helpful in modifying treatment selection in clinical routine.
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Affiliation(s)
- Jun Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Lipeng Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Ranran Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yang Wan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaowen Gong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Li Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Wenyu Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaojuan Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yao Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yumei Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Ye Guo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Min Ruan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaofan Zhu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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8
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Lejman M, Dziatkiewicz I, Jurek M. Straight to the Point-The Novel Strategies to Cure Pediatric AML. Int J Mol Sci 2022; 23:1968. [PMID: 35216084 PMCID: PMC8878466 DOI: 10.3390/ijms23041968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Although the outcome has improved over the past decades, due to improved supportive care, a better understanding of risk factors, and intensified chemotherapy, pediatric acute myeloid leukemia remains a life-threatening disease, and overall survival (OS) remains near 70%. According to French-American-British (FAB) classification, AML is divided into eight subtypes (M0-M7), and each is characterized by a different pathogenesis and response to treatment. However, the curability of AML is due to the intensification of standard chemotherapy, more precise risk classification, improvements in supportive care, and the use of minimal residual disease to monitor response to therapy. The treatment of childhood AML continues to be based primarily on intensive, conventional chemotherapy. Therefore, it is essential to identify new, more precise molecules that are targeted to the specific abnormalities of each leukemia subtype. Here, we review abnormalities that are potential therapeutic targets for the treatment of AML in the pediatric population.
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Affiliation(s)
- Monika Lejman
- Laboratory of Genetic Diagnostics, II Faculty of Pediatrics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland
| | - Izabela Dziatkiewicz
- Student Scientific Society, Laboratory of Genetic Diagnostics, II Faculty of Pediatrics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland; (I.D.); (M.J.)
| | - Mateusz Jurek
- Student Scientific Society, Laboratory of Genetic Diagnostics, II Faculty of Pediatrics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland; (I.D.); (M.J.)
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9
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Molina Garay C, Carrillo Sánchez K, Flores Lagunes LL, Jiménez Olivares M, Muñoz Rivas A, Villegas Torres BE, Flores Aguilar H, Núñez Enríquez JC, Jiménez Hernández E, Bekker Méndez VC, Torres Nava JR, Flores Lujano J, Martín Trejo JA, Mata Rocha M, Medina Sansón A, Espinoza Hernández LE, Peñaloza Gonzalez JG, Espinosa Elizondo RM, Flores Villegas LV, Amador Sanchez R, Pérez Saldívar ML, Sepúlveda Robles OA, Rosas Vargas H, Jiménez Morales S, Galindo Delgado P, Mejía Aranguré JM, Alaez Verson C. Mutational Landscape of CEBPA in Mexican Pediatric Acute Myeloid Leukemia Patients: Prognostic Implications. Front Pediatr 2022; 10:899742. [PMID: 35967564 PMCID: PMC9367218 DOI: 10.3389/fped.2022.899742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Mexico, the incidence of acute myeloid leukemia (AML) has increased in the last few years. Mortality is higher than in developed countries, even though the same chemotherapy protocols are used. CCAAT Enhancer Binding Protein Alpha (CEBPA) mutations are recurrent in AML, influence prognosis, and help to define treatment strategies. CEBPA mutational profiles and their clinical implications have not been evaluated in Mexican pediatric AML patients. AIM OF THE STUDY To identify the mutational landscape of the CEBPA gene in pediatric patients with de novo AML and assess its influence on clinical features and overall survival (OS). MATERIALS AND METHODS DNA was extracted from bone marrow aspirates at diagnosis. Targeted massive parallel sequencing of CEBPA was performed in 80 patients. RESULTS CEBPA was mutated in 12.5% (10/80) of patients. Frameshifts at the N-terminal region were the most common mutations 57.14% (8/14). CEBPA biallelic (CEBPA BI) mutations were identified in five patients. M2 subtype was the most common in CEBPA positive patients (CEBPA POS) (p = 0.009); 50% of the CEBPA POS patients had a WBC count > 100,000 at diagnosis (p = 0.004). OS > 1 year was significantly better in CEBPA negative (CEBPA NEG) patients (p = 0.0001). CEBPA POS patients (either bi- or monoallelic) had a significantly lower OS (p = 0.002). Concurrent mutations in FLT3, CSF3R, and WT1 genes were found in CEBPA POS individuals. Their contribution to poor OS cannot be ruled out. CONCLUSION CEBPA mutational profiles in Mexican pediatric AML patients and their clinical implications were evaluated for the first time. The frequency of CEBPA POS was in the range reported for pediatric AML (4.5-15%). CEBPA mutations showed a negative impact on OS as opposed to the results of other studies.
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Affiliation(s)
- Carolina Molina Garay
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Karol Carrillo Sánchez
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | - Marco Jiménez Olivares
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Anallely Muñoz Rivas
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | | | - Juan Carlos Núñez Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Elva Jiménez Hernández
- Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional (CMN) "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Vilma Carolina Bekker Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología "Dr. Daniel Méndez Hernández", "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - José Refugio Torres Nava
- Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaria de Salud del D.F., Mexico City, Mexico
| | - Janet Flores Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Jorge Alfonso Martín Trejo
- Servicio de Hematología Pediátrica, UMAE Hospital de Pediatría, Centro Médico Nacional (CMN) "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Minerva Mata Rocha
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aurora Medina Sansón
- Servicio de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaria de Salud (SSa), Mexico City, Mexico
| | - Laura Eugenia Espinoza Hernández
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | | | - Luz Victoria Flores Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional (CMN) "20 de Noviembre", Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Raquel Amador Sanchez
- Hospital General Regional No. 1 "Carlos McGregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - María Luisa Pérez Saldívar
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Omar Alejandro Sepúlveda Robles
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional (CMN) "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Haydeé Rosas Vargas
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional (CMN) "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Silvia Jiménez Morales
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (Inmegen), Mexico City, Mexico
| | | | - Juan Manuel Mejía Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (Inmegen), Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carmen Alaez Verson
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
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10
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Fornerod M, Ma J, Noort S, Liu Y, Walsh MP, Shi L, Nance S, Liu Y, Wang Y, Song G, Lamprecht T, Easton J, Mulder HL, Yergeau D, Myers J, Kamens JL, Obeng EA, Pigazzi M, Jarosova M, Kelaidi C, Polychronopoulou S, Lamba JK, Baker SD, Rubnitz JE, Reinhardt D, van den Heuvel-Eibrink MM, Locatelli F, Hasle H, Klco JM, Downing JR, Zhang J, Pounds S, Zwaan CM, Gruber TA. Integrative Genomic Analysis of Pediatric Myeloid-Related Acute Leukemias Identifies Novel Subtypes and Prognostic Indicators. Blood Cancer Discov 2021; 2:586-599. [PMID: 34778799 PMCID: PMC8580615 DOI: 10.1158/2643-3230.bcd-21-0049] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022] Open
Abstract
Integrating somatic mutation analysis and gene expression profiling distinguishes pediatric AML subtypes with differential prognoses and clinical risks. Genomic characterization of pediatric patients with acute myeloid leukemia (AML) has led to the discovery of somatic mutations with prognostic implications. Although gene-expression profiling can differentiate subsets of pediatric AML, its clinical utility in risk stratification remains limited. Here, we evaluate gene expression, pathogenic somatic mutations, and outcome in a cohort of 435 pediatric patients with a spectrum of pediatric myeloid-related acute leukemias for biological subtype discovery. This analysis revealed 63 patients with varying immunophenotypes that span a T-lineage and myeloid continuum designated as acute myeloid/T-lymphoblastic leukemia (AMTL). Within AMTL, two patient subgroups distinguished by FLT3-ITD and PRC2 mutations have different outcomes, demonstrating the impact of mutational composition on survival. Across the cohort, variability in outcomes of patients within isomutational subsets is influenced by transcriptional identity and the presence of a stem cell–like gene-expression signature. Integration of gene expression and somatic mutations leads to improved risk stratification.
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Affiliation(s)
- Maarten Fornerod
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Pediatric Oncology Hematology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sanne Noort
- Department of Pediatric Oncology Hematology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Yu Liu
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Michael P Walsh
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Lei Shi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephanie Nance
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yanling Liu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yuanyuan Wang
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Guangchun Song
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tamara Lamprecht
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather L Mulder
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Donald Yergeau
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jacquelyn Myers
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer L Kamens
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Esther A Obeng
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Martina Pigazzi
- Department of Women's and Children's Health, Hematology Oncology Clinic and Lab, University of Padova, IRP, Padova, Italy.,Department of Pediatric Hematology Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Sapienza, University of Rome, Rome, Italy
| | - Marie Jarosova
- Department of Internal Medicine Hematology and Oncology Center of Molecular Biology and Gene Therapy, Masaryk University Hospital, Brno, Czech Republic
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology Aghia Sophia Children's Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology Aghia Sophia Children's Hospital, Athens, Greece
| | - Jatinder K Lamba
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Sharyn D Baker
- Division of Pharmaceutics, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Dirk Reinhardt
- Department of Pediatrics, University Hospital Essen, Essen, Germany
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology Hematology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Franco Locatelli
- Department of Pediatric Hematology Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Sapienza, University of Rome, Rome, Italy
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University, Aarhus, Denmark
| | - Jeffery M Klco
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James R Downing
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stanley Pounds
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - C Michel Zwaan
- Department of Pediatric Oncology Hematology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Tanja A Gruber
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
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11
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Chen X, Wang X, Dou H, Yang Z, Bi J, Huang Y, Lu L, Yu J, Bao L. Cytogenetic and mutational analysis and outcome assessment of a cohort of 284 children with de novo acute myeloid leukemia reveal complex karyotype as an adverse risk factor for inferior survival. Mol Cytogenet 2021; 14:27. [PMID: 34011412 PMCID: PMC8136172 DOI: 10.1186/s13039-021-00547-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is rare in children. Although complex karyotype (CK) defined as ≥ 3 cytogenetic abnormalities is an adverse risk factor in adult AML, its prognostic impact on childhood AML remains to be determined. Results We studied the prevalence, cytogenetic and mutational features, and outcome impact of CK in a cohort of 284 Chinese children with de novo AML. Thirty-four (12.0%) children met the criteria for CK-AML with atypical CK being more frequent than typical CK featured with -5/5q-, -7/7q-, and/or 17p aberration. Mutational prevalence was low and co-occurrence mutants were uncommon. Children with CK-AML showed shorter overall survival (OS) (5-year OS: 26.7 ± 10.6% vs. 37.5 ± 8.6%, p = 0.053) and event-free survival (EFS) (5-year EFS: 26.7 ± 10.6% vs. 38.8 ± 8.6%, p = 0.039) compared with those with intermediate-risk genetics. Typical CK tended to correlate with a decreased OS than atypical CK (5-year OS: 0 vs. 33 ± 12.7%.; p = 0.084), and CK with ≥ 5 cytogenetic aberrations was associated with an inferior survival compared with CK with ≤ 4 aberrations (5-year OS: 13.6 ± 11.7% vs. 50.0 ± 18.6%; p = 0.040; 5-year EFS: 13.6 ± 11.7% vs. 50.0 ± 18.6%; p = 0.048). Conclusion Our results demonstrate CK as an adverse risk factor for reduced survival in childhood AML. Our findings shed light on the cytogenetic and mutational profile of childhood CK-AML and would inform refinement of risk stratification in childhood AML to improve outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13039-021-00547-0.
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Affiliation(s)
- Xi Chen
- Center for Clinical Molecular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xingjuan Wang
- Center for Reproductive Medicine, Baoji Maternal and Child Health Hospital, Shanxi, China
| | - Hu Dou
- Department of Clinical Laboratory, Key Laboratory of Pediatrics in Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenzhen Yang
- Department of Clinical Laboratory, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Junqin Bi
- Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi Huang
- Chongqing Key Laboratory of Child Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Ling Lu
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Yu
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshang 2nd Road, Chongqing, 400014, China.
| | - Liming Bao
- Department of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, 12705 E. Montview Boulevard, Suite 400, Aurora, CO, 80045, USA.
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12
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Wang Y, Weng WJ, Zhou DH, Fang JP, Mishra S, Chai L, Xu LH. Wilms Tumor 1 Mutations Are Independent Poor Prognostic Factors in Pediatric Acute Myeloid Leukemia. Front Oncol 2021; 11:632094. [PMID: 33968731 PMCID: PMC8096913 DOI: 10.3389/fonc.2021.632094] [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] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
The prognostic impact of Wilms tumor 1 (WT1) mutations remains controversial for patients with acute myeloid leukemia (AML). Here, we aimed to determine the clinical implication of WT1 mutations in a large cohort of pediatric AML. The clinical data of 870 pediatric patients with AML were downloaded from the therapeutically applicable research to generate effective treatment (TARGET) dataset. We analyzed the prevalence, clinical profile, and prognosis of AML patients with WT1 mutations in this cohort. Our results showed that 6.7% of total patients harbored WT1 mutations. These WT1 mutations were closely associated with normal cytogenetics (P<0.001), FMS-like tyrosine kinase 3/internal tandem duplication (FLT3/ITD) mutations (P<0.001), and low complete remission induction rates (P<0.01). Compared to the patients without WT1 mutations, patients with WT1 mutations had a worse 5-year event-free survival (21.7 ± 5.5% vs 48.9 ± 1.8%, P<0.001) and a worse overall survival (41.4 ± 6.6% vs 64.3 ± 1.7%, P<0.001). Moreover, patients with both WT1 and FLT3/ITD mutations had a dismal prognosis. Compared to chemotherapy alone, hematopoietic stem cell transplantation tended to improve the prognoses of WT1-mutated patients. Multivariate analysis demonstrated that WT1 mutations conferred an independent adverse impact on event-free survival (hazard ratio 1.910, P = 0.001) and overall survival (hazard ratio 1.709, P = 0.020). In conclusion, our findings have demonstrated that WT1 mutations are independent poor prognostic factors in pediatric AML.
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Affiliation(s)
- Yin Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen-Jun Weng
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dun-Hua Zhou
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-Pei Fang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Srishti Mishra
- Cancer Science Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Li Chai
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lu-Hong Xu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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13
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Conneely SE, Stevens AM. Acute Myeloid Leukemia in Children: Emerging Paradigms in Genetics and New Approaches to Therapy. Curr Oncol Rep 2021; 23:16. [PMID: 33439382 PMCID: PMC7806552 DOI: 10.1007/s11912-020-01009-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Acute myeloid leukemia (AML) in children remains a challenging disease to cure with suboptimal outcomes particularly when compared to the more common lymphoid leukemias. Recent advances in the genetic characterization of AML have enhanced understanding of individualized patient risk, which has also led to the development of new therapeutic strategies. Here, we review key cytogenetic and molecular features of pediatric AML and how new therapies are being used to improve outcomes. RECENT FINDINGS Recent studies have revealed an increasing number of mutations, including WT1, CBFA2T3-GLIS2, and KAT6A fusions, DEK-NUP214 and NUP98 fusions, and specific KMT2A rearrangements, which are associated with poor outcomes. However, outcomes are starting to improve with the addition of therapies such as gemtuzumab ozogamicin and FLT3 inhibitors, initially developed in adult AML. The combination of advanced risk stratification and ongoing improvements and innovations in treatment strategy will undoubtedly lead to better outcomes for children with AML.
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Affiliation(s)
- Shannon E Conneely
- Department of Pediatric Hematology/Oncology, Baylor College of Medicine/Texas Children's Hospital, 6701 Fannin, Suite 1510, Houston, TX, 77030, USA.
| | - Alexandra M Stevens
- Department of Pediatric Hematology/Oncology, Baylor College of Medicine/Texas Children's Hospital, 6701 Fannin, Suite 1510, Houston, TX, 77030, USA
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14
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Abstract
Acute myeloid leukemia (AML) is a clinically, morphologically, and genetically heterogeneous disorder. Like many malignancies, the genomic landscape of pediatric AML has been mapped recently through sequencing of large cohorts of patients. Much has been learned about the biology of AML through studies of specific recurrent genetic lesions. Further, genetic lesions have been linked to specific clinical features, response to therapy, and outcome, leading to improvements in risk stratification. Lastly, targeted therapeutic approaches have been developed for the treatment of specific genetic lesions, some of which are already having a positive impact on outcomes. While the advances made based on the discoveries of sequencing studies are significant, much work is left. The biologic, clinical, and prognostic impact of a number of genetic lesions, including several seemingly unique to pediatric patients, remains undefined. While targeted approaches are being explored, for most, the efficacy and tolerability when incorporated into standard therapy is yet to be determined. Furthermore, the challenge of how to study small subpopulations with rare genetic lesions in an already rare disease will have to be considered. In all, while questions and challenges remain, precisely defining the genomic landscape of AML, holds great promise for ultimately leading to improved outcomes for affected patients.
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Affiliation(s)
- Shannon E Conneely
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Avenue, Feigin Tower, Suite 1025, Houston, TX, 77030, USA
| | - Rachel E Rau
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Avenue, Feigin Tower, Suite 1025, Houston, TX, 77030, USA.
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15
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Xu J, Zhang Y, Hu J, Ren Y, Wang H. Clinical features and prognosis of normal karyotype acute myeloid leukemia pediatric patients with WT1 mutations: an analysis based on TCGA database. ACTA ACUST UNITED AC 2020; 25:79-84. [PMID: 32019476 DOI: 10.1080/16078454.2020.1720102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To explore the clinical features and prognosis of normal karyotype acute myeloid leukemia (NK-AML) pediatric patients with WT1 mutations.Methods: The clinical data and prognostic information of 220 NK-AML pediatric patients were selected from target-AML project of The Cancer Genome Atlas (TCGA) database. Survival analyses were performed for NK-AML pediatric patients with different combinations of mutations.Results: We found that 28(12.7%) NK-AML patients harbored WT1 mutations. The positive rate of FLT3-ITD in the WT1-mutated group was higher than that in the WT1 wild-type group (P = 0.002). In contrast, WT1 mutation and NPM1 mutation were mutually exclusive (P = 0.013). Furthermore, the WT1-mutated group suffered lower rates of complete remission (CR) (P < 0.001 and P < 0.001, respectively) but higher rates of minimal residual disease (MRD) (P = 0.003 and P = 0.021, respectively) after both one and two courses of induction chemotherapy. Patients with WT1 mutations had significantly worse overall survival (OS) and event-free survival (EFS) in both univariate (P < 0.001 and P = 0.007, respectively) and multivariate survival analyses (P < 0.001 and P < 0.001, respectively). The stratification analysis showed that for FLT3-ITD positive patients, WT1 mutations predicted shorter OS (P = 0.003) and EFS (P < 0.001).Conclusion: WT1 mutations conferred an independent poor prognosis for NK-AML pediatric patients.
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Affiliation(s)
- Jing Xu
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yaofang Zhang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Jinjun Hu
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yan Ren
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hongwei Wang
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, People's Republic of China.,Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
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16
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Green SD, Konig H. Treatment of Acute Myeloid Leukemia in the Era of Genomics-Achievements and Persisting Challenges. Front Genet 2020; 11:480. [PMID: 32536937 PMCID: PMC7267060 DOI: 10.3389/fgene.2020.00480] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/17/2020] [Indexed: 01/15/2023] Open
Abstract
Acute myeloid leukemia (AML) represents a malignant disorder of the hematopoietic system that is mainly characterized by rapid proliferation, dysregulated apoptosis, and impaired differentiation of leukemic blasts. For several decades, the diagnostic approach in AML was largely based on histologic characteristics with little impact on the treatment decision-making process. This perspective has drastically changed within the past years due to the advent of novel molecular technologies, such as whole genome next-generation sequencing (NGS), and the resulting knowledge gain in AML biology and pathogenesis. After more than four decades of intensive chemotherapy as a "one-size-fits-all" concept, several targeted agents have recently been approved for the treatment of AML, either as single agents or as part of combined treatment regimens. Several other compounds, directed against regulators of apoptotic, epigenetic, or microenvironmental pathways, as well as modulators of the immune system, are currently in development and being investigated in clinical trials. The constant progress in AML research has started to produce improved survival rates and fueled hopes that a once rapidly fatal disease can be transformed into a chronic condition. In this review, the authors provide a summary of recent advances in the development of targeted AML therapies and discuss persistent challenges.
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Affiliation(s)
| | - Heiko Konig
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
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17
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Abstract
PURPOSE OF REVIEW Despite advances in therapy over the past decades, overall survival for children with acute myeloid leukemia (AML) has not exceeded 70%. In this review, we highlight recent insights into risk stratification for patients with pediatric AML and discuss data driving current and developing therapeutic approaches. RECENT FINDINGS Advances in cytogenetics and molecular profiling, as well as improvements in detection of minimal residual disease after induction therapy, have informed risk stratification, which now relies heavily on these elements. The treatment of childhood AML continues to be based primarily on intensive, conventional chemotherapy. However, recent trials focus on limiting treatment-related toxicity through the identification of low-risk subsets who can safely receive fewer cycles of chemotherapy, allocation of hematopoietic stem-cell transplant to only high-risk patients and optimization of infectious and cardioprotective supportive care. SUMMARY Further incorporation of genomic and molecular data in pediatric AML will allow for additional refinements in risk stratification to enable the tailoring of treatment intensity. These data will also dictate the incorporation of molecularly targeted therapeutics into frontline treatment in the hope of improving survival while decreasing treatment-related toxicity.
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18
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Mutated WT1, FLT3-ITD, and NUP98-NSD1 Fusion in Various Combinations Define a Poor Prognostic Group in Pediatric Acute Myeloid Leukemia. JOURNAL OF ONCOLOGY 2019; 2019:1609128. [PMID: 31467532 PMCID: PMC6699323 DOI: 10.1155/2019/1609128] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Abstract
Acute myeloid leukemia is a life-threatening malignancy in children and adolescents treated predominantly by risk-adapted intensive chemotherapy that is partly supported by allogeneic stem cell transplantation. Mutations in the WT1 gene and NUP98-NSD1 fusion are predictors of poor survival outcome/prognosis that frequently occur in combination with internal tandem duplications of the juxta-membrane domain of FLT3 (FLT3-ITD). To re-evaluate the effect of these factors in contemporary protocols, 353 patients (<18 years) treated in Germany with AML-BFM treatment protocols between 2004 and 2017 were included. Presence of mutated WT1 and FLT3-ITD in blasts (n=19) resulted in low 3-year event-free survival of 29% and overall survival of 33% compared to rates of 45-63% and 67-87% in patients with only one (only FLT3-ITD; n=33, only WT1 mutation; n=29) or none of these mutations (n=272). Including NUP98-NSD1 and high allelic ratio (AR) of FLT3-ITD (AR ≥0.4) in the analysis revealed very poor outcomes for patients with co-occurrence of all three factors or any of double combinations. All these patients (n=15) experienced events and the probability of overall survival was low (27%). We conclude that co-occurrence of WT1 mutation, NUP98-NSD1, and FLT3-ITD with an AR ≥0.4 as triple or double mutations still predicts dismal response to contemporary first- and second-line treatment for pediatric acute myeloid leukemia.
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19
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Abstract
Acute myeloid leukemia (AML) is a kind of malignant hematopoietic system disease characterized by abnormal proliferation, poor cell differentiation, and infiltration of bone marrow, peripheral blood, or other tissues. To date, the first-line treatment of AML is still based on daunorubicin and cytosine arabinoside or idarubicin and cytosine arabinoside regimen. However, the complete remission rate of AML is still not optimistic, especially in elderly patients, and the recurrence rate after complete remission is still high. The resistance of leukemia cells to chemotherapy drugs becomes the main obstacle in the treatment of AML. At present, the research on the mechanisms of drug resistance in AML is very active. This article will elaborate on the main mechanisms of drug resistance currently being studied, including drug resistance-related proteins and enzymes, gene alterations, micro RNAs, and signal pathways.
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Affiliation(s)
- Jing Zhang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, People's Republic of China,
| | - Yan Gu
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, People's Republic of China,
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, People's Republic of China,
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20
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Mashima K, Oh I, Ikeda T, Toda Y, Ito S, Umino K, Minakata D, Nakano H, Morita K, Yamasaki R, Kawasaki Y, Sugimoto M, Yamamoto C, Ashizawa M, Fujiwara SI, Hatano K, Sato K, Omine K, Muroi K, Kanda Y. Role of Sequential Monitoring of WT1 Gene Expression in Patients With Acute Myeloid Leukemia for the Early Detection of Leukemia Relapse. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e521-e527. [DOI: 10.1016/j.clml.2018.07.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 01/13/2023]
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21
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Annesley CE, Rabik C, Duffield AS, Rau RE, Magoon D, Li L, Huff V, Small D, Loeb DM, Brown P. Knock-in of the Wt1 R394W mutation causes MDS and cooperates with Flt3/ITD to drive aggressive myeloid neoplasms in mice. Oncotarget 2018; 9:35313-35326. [PMID: 30450160 PMCID: PMC6219680 DOI: 10.18632/oncotarget.26238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/05/2018] [Indexed: 12/18/2022] Open
Abstract
Wilms tumor 1 (WT1) is a zinc finger transcriptional regulator, and has been implicated as both a tumor suppressor and oncogene in various malignancies. Mutations in the DNA-binding domain of the WT1 gene are described in 10-15% of normal-karyotype AML (NK-AML) in pediatric and adult patients. Similar WT1 mutations have been reported in adult patients with myelodysplastic syndrome (MDS). WT1 mutations have been independently associated with treatment failure and poor prognosis in NK-AML. Internal tandem duplication (ITD) mutations of FMS-like tyrosine kinase 3 (FLT3) commonly co-occur with WT1-mutant AML, suggesting a cooperative role in leukemogenesis. The functional role of WT1 mutations in hematologic malignancies appears to be complex and is not yet fully elucidated. Here, we describe the hematologic phenotype of a knock-in mouse model of a Wt1 mutation (R394W), described in cases of human leukemia. We show that Wt1 +/R394W mice develop MDS which becomes 100% penetrant in a transplant model, exhibit an aberrant expansion of myeloid progenitor cells, and demonstrate enhanced self-renewal of hematopoietic progenitor cells in vitro. We crossbred Wt1 +/R394W mice with knock-in Flt3 +/ITD mice, and show that mice with both mutations (Flt3 +/ITD/Wt1 +/R394W) develop a transplantable MDS/MPN, with more aggressive features compared to either single mutant mouse model.
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Affiliation(s)
| | - Cara Rabik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy S Duffield
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel E Rau
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Magoon
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Li Li
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vicki Huff
- Department of Molecular Genetics/Cancer Genetics, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Donald Small
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Loeb
- Current affiliation: Departments of Pediatrics and Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patrick Brown
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Allogeneic hematopoietic stem cell transplantation for children and adolescents with high-risk cytogenetic AML: distinctly poor outcomes of FUS-ERG-positive cases. Bone Marrow Transplant 2018; 54:393-401. [PMID: 29959436 DOI: 10.1038/s41409-018-0273-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022]
Abstract
Allocating patients with acute myeloid leukemia and high-risk cytogenetic abnormalities (HR-AML) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) is part of the standard treatment protocol; however, whether allo-HSCT truly improves the outcomes in these patients is debatable. Data on 169 children and adolescents with HR-AML who received their first allo-HSCT in first or second remission between 2000 and 2015 were extracted from a nationwide, Japanese HSCT registry. The 3-year disease-free survival (DFS) and overall survival (OS) rates were 55.2% (95% CI, 46.8-62.9%) and 69.6% (61.4-76.3%), respectively, for all the HR-AML patients. In univariate analysis, the cytogenetic subgroup had a significant impact on both the DFS (P = 0.011) and OS (P < 0.001) rates. In particular, 14 patients with t(16;21) showed an extremely poor outcome. Additionally, older age at allo-HSCT (10-19 years old, P = 0.025), myeloablative conditioning with total-body irradiation (P = 0.019), and grade II-IV acute graft-versus-host disease (GVHD, P = 0.049) were associated with inferior OS. The donor type and occurrence of chronic GVHD did not affect the outcome. Multivariate analysis revealed t(16;21) to be associated with increased overall mortality (hazard ratio = 4.416, P < 0.001). Because the outcome of patients with certain HR-AML subgroups, such as t(16;21)-positive cases, is extremely poor even with allo-HSCT in remission, a novel therapy is urgently required.
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23
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Masetti R, Castelli I, Astolfi A, Bertuccio SN, Indio V, Togni M, Belotti T, Serravalle S, Tarantino G, Zecca M, Pigazzi M, Basso G, Pession A, Locatelli F. Genomic complexity and dynamics of clonal evolution in childhood acute myeloid leukemia studied with whole-exome sequencing. Oncotarget 2018; 7:56746-56757. [PMID: 27462774 PMCID: PMC5302950 DOI: 10.18632/oncotarget.10778] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/10/2016] [Indexed: 11/25/2022] Open
Abstract
Despite significant improvement in treatment of childhood acute myeloid leukemia (AML), 30% of patients experience disease recurrence, which is still the major cause of treatment failure and death in these patients. To investigate molecular mechanisms underlying relapse, we performed whole-exome sequencing of diagnosis-relapse pairs and matched remission samples from 4 pediatric AML patients without recurrent cytogenetic alterations. Candidate driver mutations were selected for targeted deep sequencing at high coverage, suitable to detect small subclones (0.12%). BiCEBPα mutation was found to be stable and highly penetrant, representing a separate biological and clinical entity, unlike WT1 mutations, which were extremely unstable. Among the mutational patterns underlying relapse, we detected the acquisition of proliferative advantage by signaling activation (PTPN11 and FLT3-TKD mutations) and the increased resistance to apoptosis (hyperactivation of TYK2). We also found a previously undescribed feature of AML, consisting of a hypermutator phenotype caused by SETD2 inactivation. The consequent accumulation of new mutations promotes the adaptability of the leukemia, contributing to clonal selection. We report a novel ASXL3 mutation characterizing a very small subclone (<1%) present at diagnosis and undergoing expansion (60%) at relapse. Taken together, these findings provide molecular clues for designing optimal therapeutic strategies, in terms of target selection, adequate schedule design and reliable response-monitoring techniques.
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Affiliation(s)
- Riccardo Masetti
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Ilaria Castelli
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy
| | - Salvatore Nicola Bertuccio
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Valentina Indio
- Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy
| | - Marco Togni
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy.,Current address: Stem Cell Group, University College London Cancer Institute, University College London, London, United Kingdom
| | - Tamara Belotti
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Salvatore Serravalle
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Giuseppe Tarantino
- Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy
| | - Marco Zecca
- Department of Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Martina Pigazzi
- Department of Woman and Child Health, Laboratory of Hematology-Oncology, University of Padova, Padova, Italy
| | - Giuseppe Basso
- Department of Woman and Child Health, Laboratory of Hematology-Oncology, University of Padova, Padova, Italy
| | - Andrea Pession
- Department of Pediatrics "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology-Oncology, IRCCS Ospedale Bambino Gesù, Rome, Italy.,University of Pavia, Pavia, Italy
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24
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Klein K, de Haas V, Kaspers GJL. Clinical challenges in de novo pediatric acute myeloid leukemia. Expert Rev Anticancer Ther 2018; 18:277-293. [DOI: 10.1080/14737140.2018.1428091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Klein
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Valérie de Haas
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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25
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Ullmark T, Montano G, Gullberg U. DNA and RNA binding by the Wilms' tumour gene 1 (WT1) protein +KTS and −KTS isoforms-From initial observations to recent global genomic analyses. Eur J Haematol 2018; 100:229-240. [DOI: 10.1111/ejh.13010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Tove Ullmark
- Department of Haematology and Transfusion Medicine; Lund University; Lund Sweden
| | - Giorgia Montano
- Department of Haematology and Transfusion Medicine; Lund University; Lund Sweden
| | - Urban Gullberg
- Department of Haematology and Transfusion Medicine; Lund University; Lund Sweden
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26
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Larmonie NSD, Arentsen-Peters TCJM, Obulkasim A, Valerio D, Sonneveld E, Danen-van Oorschot AA, de Haas V, Reinhardt D, Zimmermann M, Trka J, Baruchel A, Pieters R, van den Heuvel-Eibrink MM, Zwaan CM, Fornerod M. MN1 overexpression is driven by loss of DNMT3B methylation activity in inv(16) pediatric AML. Oncogene 2018; 37:107-115. [PMID: 28892045 DOI: 10.1038/onc.2017.293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 06/09/2017] [Accepted: 07/17/2017] [Indexed: 12/15/2022]
Abstract
In acute myeloid leukemia (AML), specific genomic aberrations induce aberrant methylation, thus directly influencing the transcriptional programing of leukemic cells. Therefore, therapies targeting epigenetic processes are advocated as a promising therapeutic tool for AML treatment. However, to develop new therapies, a comprehensive understanding of the mechanism(s) driving the epigenetic changes as a result of acquired genetic abnormalities is necessary. This understanding is still lacking. In this study, we performed genome-wide CpG-island methylation profiling on pediatric AML samples. Six differentially methylated genomic regions within two genes, discriminating inv(16)(p13;q22) from non-inv(16) pediatric AML samples, were identified. All six regions had a hypomethylated phenotype in inv(16) AML samples, and this was most prominent at the regions encompassing the meningioma (disrupted in balanced translocation) 1 (MN1) oncogene. MN1 expression primarily correlated with the methylation level of the 3' end of the MN1 exon-1 locus. Decitabine treatment of different cell lines showed that induced loss of methylation at the MN1 locus can result in an increase of MN1 expression, indicating that MN1 expression is coregulated by DNA methylation. To investigate this methylation-associated mechanism, we determined the expression of DNA methyltransferases in inv(16) AML. We found that DNMT3B expression was significantly lower in inv(16) samples. Furthermore, DNMT3B expression correlated negatively with MN1 expression in pediatric AML samples. Importantly, depletion of DNMT3B impaired remethylation efficiency of the MN1 exon-1 locus in AML cells after decitabine exposure. These findings identify DNMT3B as an important coregulator of MN1 methylation. Taken together, this study shows that the methylation level of the MN1 exon-1 locus regulates MN1 expression levels in inv(16) pediatric AML. This methylation level is dependent on DNMT3B, thus suggesting a role for DNMT3B in leukemogenesis in inv(16) AML, through MN1 methylation regulation.
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MESH Headings
- Adolescent
- Azacitidine/analogs & derivatives
- Azacitidine/pharmacology
- Carcinogenesis/genetics
- Cell Line, Tumor
- Child
- Child, Preschool
- CpG Islands/genetics
- DNA (Cytosine-5-)-Methyltransferases/metabolism
- DNA Methylation/drug effects
- DNA Methylation/genetics
- Decitabine
- Epigenesis, Genetic/genetics
- Exons/genetics
- Female
- Gene Expression Regulation, Leukemic
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Nucleic Acid Hybridization/methods
- Oligonucleotide Array Sequence Analysis/methods
- Oncogene Proteins, Fusion/genetics
- Promoter Regions, Genetic/genetics
- Trans-Activators
- Tumor Suppressor Proteins/genetics
- DNA Methyltransferase 3B
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Affiliation(s)
- N S D Larmonie
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T C J M Arentsen-Peters
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A Obulkasim
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - D Valerio
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E Sonneveld
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - A A Danen-van Oorschot
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - V de Haas
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - D Reinhardt
- Department of Pediatric Oncology/Hematology, Medical High School, Hannover, Germany
| | - M Zimmermann
- Department of Pediatric Oncology/Hematology, Medical High School, Hannover, Germany
| | - J Trka
- Pediatric Hematology/Oncology, 2nd Medical School, Charles University, Prague, Czech Republic
| | - A Baruchel
- CHU de Paris-Hôpital Robert Debré, Paris, France
| | - R Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - C M Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Fornerod
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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27
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Bolouri H, Farrar JE, Triche T, Ries RE, Lim EL, Alonzo TA, Ma Y, Moore R, Mungall AJ, Marra MA, Zhang J, Ma X, Liu Y, Liu Y, Auvil JMG, Davidsen TM, Gesuwan P, Hermida LC, Salhia B, Capone S, Ramsingh G, Zwaan CM, Noort S, Piccolo SR, Kolb EA, Gamis AS, Smith MA, Gerhard DS, Meshinchi S. The molecular landscape of pediatric acute myeloid leukemia reveals recurrent structural alterations and age-specific mutational interactions. Nat Med 2018; 24:103-112. [PMID: 29227476 PMCID: PMC5907936 DOI: 10.1038/nm.4439] [Citation(s) in RCA: 506] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
Abstract
We present the molecular landscape of pediatric acute myeloid leukemia (AML) and characterize nearly 1,000 participants in Children's Oncology Group (COG) AML trials. The COG-National Cancer Institute (NCI) TARGET AML initiative assessed cases by whole-genome, targeted DNA, mRNA and microRNA sequencing and CpG methylation profiling. Validated DNA variants corresponded to diverse, infrequent mutations, with fewer than 40 genes mutated in >2% of cases. In contrast, somatic structural variants, including new gene fusions and focal deletions of MBNL1, ZEB2 and ELF1, were disproportionately prevalent in young individuals as compared to adults. Conversely, mutations in DNMT3A and TP53, which were common in adults, were conspicuously absent from virtually all pediatric cases. New mutations in GATA2, FLT3 and CBL and recurrent mutations in MYC-ITD, NRAS, KRAS and WT1 were frequent in pediatric AML. Deletions, mutations and promoter DNA hypermethylation convergently impacted Wnt signaling, Polycomb repression, innate immune cell interactions and a cluster of zinc finger-encoding genes associated with KMT2A rearrangements. These results highlight the need for and facilitate the development of age-tailored targeted therapies for the treatment of pediatric AML.
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Affiliation(s)
- Hamid Bolouri
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jason E Farrar
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Timothy Triche
- Jane Anne Nohl Division of Hematology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Emilia L Lim
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Children's Oncology Group, Monrovia, California, USA
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jinghui Zhang
- Division of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Xiaotu Ma
- Division of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yu Liu
- Division of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yanling Liu
- Division of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Tanja M Davidsen
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - Patee Gesuwan
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - Leandro C Hermida
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephen Capone
- Jane Anne Nohl Division of Hematology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Giridharan Ramsingh
- Jane Anne Nohl Division of Hematology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Christian Michel Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sanne Noort
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Stephen R Piccolo
- Department of Biology, Brigham Young University, Provo, Utah, USA
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Alan S Gamis
- Division of Hematology, Oncology and Bone Marrow Transplantation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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28
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Aziz H, Ping CY, Alias H, Ab Mutalib NS, Jamal R. Gene Mutations as Emerging Biomarkers and Therapeutic Targets for Relapsed Acute Myeloid Leukemia. Front Pharmacol 2017; 8:897. [PMID: 29270125 PMCID: PMC5725465 DOI: 10.3389/fphar.2017.00897] [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: 07/21/2017] [Accepted: 11/24/2017] [Indexed: 12/19/2022] Open
Abstract
It is believed that there are key differences in the genomic profile between adult and childhood acute myeloid leukemia (AML). Relapse is the significant contributor of mortality in patients with AML and remains as the leading cause of cancer death among children, posing great challenges in the treatment of AML. The knowledge about the genomic lesions in childhood AML is still premature as most genomic events defined in children were derived from adult cohorts. However, the emerging technologies of next generation sequencing have narrowed the gap of knowledge in the biology of AML by the detection of gene mutations for each sub-type which have led to the improvement in terms of prognostication as well as the use of targeted therapies. In this review, we describe the recent understanding of the genomic landscape including the prevalence of mutation, prognostic impact, and targeted therapies that will provide an insight into the pathogenesis of AML relapse in both adult and childhood cases.
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Affiliation(s)
- Habsah Aziz
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chow Y Ping
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Rahman Jamal
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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29
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Bordin F, Piovan E, Masiero E, Ambesi-Impiombato A, Minuzzo S, Bertorelle R, Sacchetto V, Pilotto G, Basso G, Zanovello P, Amadori A, Tosello V. WT1 loss attenuates the TP53-induced DNA damage response in T-cell acute lymphoblastic leukemia. Haematologica 2017; 103:266-277. [PMID: 29170254 PMCID: PMC5792271 DOI: 10.3324/haematol.2017.170431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 11/15/2017] [Indexed: 12/19/2022] Open
Abstract
Loss-of-function mutations and deletions in Wilms tumor 1 (WT1) gene are present in approximately 10% of T-cell acute lymphoblastic leukemia. Clinically, WT1 mutations are enriched in relapsed series and are associated to inferior relapse-free survival in thymic T-cell acute lymphoblastic leukemia cases. Here we demonstrate that WT1 plays a critical role in the response to DNA damage in T-cell leukemia. WT1 loss conferred resistance to DNA damaging agents and attenuated the transcriptional activation of important apoptotic regulators downstream of TP53 in TP53-competent MOLT4 T-leukemia cells but not in TP53-mutant T-cell acute lymphoblastic leukemia cell lines. Notably, WT1 loss positively affected the expression of the X-linked inhibitor of apoptosis protein, XIAP, and genetic or chemical inhibition with embelin (a XIAP inhibitor) significantly restored sensitivity to γ-radiation in both T-cell acute lymphoblastic leukemia cell lines and patient-derived xenografts. These results reveal an important role for the WT1 tumor suppressor gene in the response to DNA damage, and support the view that anti-XIAP targeted therapies could have a role in the treatment of WT1-mutant T-cell leukemia.
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Affiliation(s)
- Fulvio Bordin
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Italy
| | - Erich Piovan
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Italy.,U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Elena Masiero
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Alberto Ambesi-Impiombato
- Institute for Cancer Genetics, Columbia University, New York, NY, USA.,PsychoGenics Inc., Tarrytown, New York, NY, USA
| | - Sonia Minuzzo
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Italy
| | - Roberta Bertorelle
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Valeria Sacchetto
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Giorgia Pilotto
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Italy
| | - Giuseppe Basso
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, Italy
| | - Paola Zanovello
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Italy.,U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Alberto Amadori
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Italy.,U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Valeria Tosello
- U.O.C. Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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30
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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31
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Hackl H, Astanina K, Wieser R. Molecular and genetic alterations associated with therapy resistance and relapse of acute myeloid leukemia. J Hematol Oncol 2017; 10:51. [PMID: 28219393 PMCID: PMC5322789 DOI: 10.1186/s13045-017-0416-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/04/2017] [Indexed: 12/31/2022] Open
Abstract
Background The majority of individuals with acute myeloid leukemia (AML) respond to initial chemotherapy and achieve a complete remission, yet only a minority experience long-term survival because a large proportion of patients eventually relapse with therapy-resistant disease. Relapse therefore represents a central problem in the treatment of AML. Despite this, and in contrast to the extensive knowledge about the molecular events underlying the process of leukemogenesis, information about the mechanisms leading to therapy resistance and relapse is still limited. Purpose and content of review Recently, a number of studies have aimed to fill this gap and provided valuable information about the clonal composition and evolution of leukemic cell populations during the course of disease, and about genetic, epigenetic, and gene expression changes associated with relapse. In this review, these studies are summarized and discussed, and the data reported in them are compiled in order to provide a resource for the identification of molecular aberrations recurrently acquired at, and thus potentially contributing to, disease recurrence and the associated therapy resistance. This survey indeed uncovered genetic aberrations with known associations with therapy resistance that were newly gained at relapse in a subset of patients. Furthermore, the expression of a number of protein coding and microRNA genes was reported to change between diagnosis and relapse in a statistically significant manner. Conclusions Together, these findings foster the expectation that future studies on larger and more homogeneous patient cohorts will uncover pathways that are robustly associated with relapse, thus representing potential targets for rationally designed therapies that may improve the treatment of patients with relapsed AML, or even facilitate the prevention of relapse in the first place. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0416-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hubert Hackl
- Division of Bioinformatics, Biocenter, Medical University of Innsbruck, Innrain 80, 6020, Innsbruck, Austria
| | - Ksenia Astanina
- Department of Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Rotraud Wieser
- Department of Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria.
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32
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Ullmark T, Järvstråt L, Sandén C, Montano G, Jernmark-Nilsson H, Lilljebjörn H, Lennartsson A, Fioretos T, Drott K, Vidovic K, Nilsson B, Gullberg U. Distinct global binding patterns of the Wilms tumor gene 1 (WT1) -KTS and +KTS isoforms in leukemic cells. Haematologica 2016; 102:336-345. [PMID: 27612989 DOI: 10.3324/haematol.2016.149815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/05/2016] [Indexed: 12/29/2022] Open
Abstract
The zinc finger transcription factor Wilms tumor gene 1 (WT1) acts as an oncogene in acute myeloid leukemia. A naturally occurring alternative splice event between zinc fingers three and four, removing or retaining three amino acids (±KTS), is believed to change the DNA binding affinity of WT1, although there are conflicting data regarding the binding affinity and motifs of the different isoforms. Increased expression of the WT1 -KTS isoform at the expense of the WT1 +KTS isoform is associated with poor prognosis in acute myeloid leukemia. We determined the genome-wide binding pattern of WT1 -KTS and WT1 +KTS in leukemic K562 cells by chromatin immunoprecipitation and deep sequencing. We discovered that the WT1 -KTS isoform predominantly binds close to transcription start sites and to enhancers, in a similar fashion to other transcription factors, whereas WT1 +KTS binding is enriched within gene bodies. We observed a significant overlap between WT1 -KTS and WT1 +KTS target genes, despite the binding sites being distinct. Motif discovery revealed distinct binding motifs for the isoforms, some of which have been previously reported as WT1 binding sites. Additional analyses showed that both WT1 -KTS and WT1 +KTS target genes are more likely to be transcribed than non-targets, and are involved in cell proliferation, cell death, and development. Our study provides evidence that WT1 -KTS and WT1 +KTS share target genes yet still bind distinct locations, indicating isoform-specific regulation in transcription of genes related to cell proliferation and differentiation, consistent with the involvement of WT1 in acute myeloid leukemia.
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Affiliation(s)
- Tove Ullmark
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Linnea Järvstråt
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Carl Sandén
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Giorgia Montano
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Helena Jernmark-Nilsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Henrik Lilljebjörn
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Andreas Lennartsson
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Thoas Fioretos
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Kristina Drott
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Karina Vidovic
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Björn Nilsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
| | - Urban Gullberg
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Huddinge, Sweden
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33
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Kavianpour M, Ahmadzadeh A, Shahrabi S, Saki N. Significance of oncogenes and tumor suppressor genes in AML prognosis. Tumour Biol 2016; 37:10041-52. [DOI: 10.1007/s13277-016-5067-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 05/05/2016] [Indexed: 12/31/2022] Open
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34
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Abstract
In this chapter, the role of WT1 in childhood cancer is discussed, using the key examples Wilms' tumor, desmoplastic small round cell of childhood, and leukemia. The role of WT1 in each disease is described and mirrored to the role of WT1 in normal development.
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Affiliation(s)
- Jocelyn Charlton
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Kathy Pritchard-Jones
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Hugh and Catherine Stevenson Professor of Paediatric Oncology, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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35
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A systematic review and meta-analysis of the impact of WT1 polymorphism rs16754 in the effectiveness of standard chemotherapy in patients with acute myeloid leukemia. THE PHARMACOGENOMICS JOURNAL 2015; 16:30-40. [DOI: 10.1038/tpj.2015.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 08/26/2015] [Accepted: 11/02/2015] [Indexed: 11/09/2022]
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36
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Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, De Bont ESJM, De Moerloose B, Dworzak M, Gibson BES, Hasle H, Leverger G, Locatelli F, Ragu C, Ribeiro RC, Rizzari C, Rubnitz JE, Smith OP, Sung L, Tomizawa D, van den Heuvel-Eibrink MM, Creutzig U, Kaspers GJL. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia. J Clin Oncol 2015; 33:2949-62. [PMID: 26304895 DOI: 10.1200/jco.2015.62.8289] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diagnosis, treatment, response monitoring, and outcome of pediatric acute myeloid leukemia (AML) have made enormous progress during the past decades. Because AML is a rare type of childhood cancer, with an incidence of approximately seven occurrences per 1 million children annually, national and international collaborative efforts have evolved. This overview describes these efforts and includes a summary of the history and contributions of each of the main collaborative pediatric AML groups worldwide. The focus is on translational and clinical research, which includes past, current, and future clinical trials. Separate sections concern acute promyelocytic leukemia, myeloid leukemia of Down syndrome, and relapsed AML. A plethora of novel antileukemic agents that have emerged, including new classes of drugs, are summarized as well. Finally, an important aspect of the treatment of pediatric AML--supportive care--and late effects are discussed. The future is bright, with a wide range of emerging innovative therapies and with more and more international collaboration that ultimately aim to cure all children with AML, with fewer adverse effects and without late effects.
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Affiliation(s)
- C Michel Zwaan
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Edward A Kolb
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Dirk Reinhardt
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jonas Abrahamsson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Souichi Adachi
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Richard Aplenc
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Eveline S J M De Bont
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Barbara De Moerloose
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Michael Dworzak
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Brenda E S Gibson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Henrik Hasle
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Guy Leverger
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Franco Locatelli
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Christine Ragu
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Raul C Ribeiro
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Carmelo Rizzari
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jeffrey E Rubnitz
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Owen P Smith
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Lillian Sung
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Daisuke Tomizawa
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Marry M van den Heuvel-Eibrink
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Ursula Creutzig
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Gertjan J L Kaspers
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
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de Rooij JDE, Zwaan CM, van den Heuvel-Eibrink M. Pediatric AML: From Biology to Clinical Management. J Clin Med 2015; 4:127-49. [PMID: 26237023 PMCID: PMC4470244 DOI: 10.3390/jcm4010127] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022] Open
Abstract
Pediatric acute myeloid leukemia (AML) represents 15%–20% of all pediatric acute leukemias. Survival rates have increased over the past few decades to ~70%, due to improved supportive care, optimized risk stratification and intensified chemotherapy. In most children, AML presents as a de novo entity, but in a minority, it is a secondary malignancy. The diagnostic classification of pediatric AML includes a combination of morphology, cytochemistry, immunophenotyping and molecular genetics. Outcome is mainly dependent on the initial response to treatment and molecular and cytogenetic aberrations. Treatment consists of a combination of intensive anthracycline- and cytarabine-containing chemotherapy and stem cell transplantation in selected genetic high-risk cases or slow responders. In general, ~30% of all pediatric AML patients will suffer from relapse, whereas 5%–10% of the patients will die due to disease complications or the side-effects of the treatment. Targeted therapy may enhance anti-leukemic efficacy and minimize treatment-related morbidity and mortality, but requires detailed knowledge of the genetic abnormalities and aberrant pathways involved in leukemogenesis. These efforts towards future personalized therapy in a rare disease, such as pediatric AML, require intensive international collaboration in order to enhance the survival rates of pediatric AML, while aiming to reduce long-term toxicity.
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Affiliation(s)
- Jasmijn D E de Rooij
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, 3015CN Rotterdam, The Netherlands.
| | - C Michel Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, 3015CN Rotterdam, The Netherlands.
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Krauth MT, Alpermann T, Bacher U, Eder C, Dicker F, Ulke M, Kuznia S, Nadarajah N, Kern W, Haferlach C, Haferlach T, Schnittger S. WT1 mutations are secondary events in AML, show varying frequencies and impact on prognosis between genetic subgroups. Leukemia 2014; 29:660-7. [DOI: 10.1038/leu.2014.243] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/29/2014] [Accepted: 08/01/2014] [Indexed: 12/14/2022]
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Bachas C, Schuurhuis GJ, Reinhardt D, Creutzig U, Kwidama ZJ, Zwaan CM, van den Heuvel-Eibrink MM, De Bont ESJM, Elitzur S, Rizzari C, de Haas V, Zimmermann M, Cloos J, Kaspers GJL. Clinical relevance of molecular aberrations in paediatric acute myeloid leukaemia at first relapse. Br J Haematol 2014; 166:902-10. [PMID: 24962064 DOI: 10.1111/bjh.12989] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/05/2014] [Indexed: 01/17/2023]
Abstract
Outcome for relapsed paediatric acute myeloid leukaemia (AML) remains poor. Strong prognostic factors at first relapse are lacking, which hampers optimization of therapy. We assessed the frequency of molecular aberrations (FLT3, NRAS, KRAS, KIT, WT1 and NPM1 genes) at first relapse in a large set (n = 198) of relapsed non-French-American-British M3, non-Down syndrome AML patients that received similar relapse treatment. We correlated molecular aberrations with clinical and biological factors and studied their prognostic relevance. Hotspot mutations in the analysed genes were detected in 92 out of 198 patients (46·5%). In 72 of these 92 patients (78%), molecular aberrations were mutually exclusive for the currently analysed genes. FLT3-internal tandem repeat (ITD) (18% of total group) mutations were most frequent, followed by NRAS (10·2%), KRAS (8%), WT1 (8%), KIT (8%), NPM1 (5%) and FLT3-tyrosine kinase domain (3%) mutations. Presence of a WT1 aberration was an independent risk factor for second relapse (Hazard Ratio [HR] = 2·74, P = 0·013). In patients who achieved second complete remission (70·2%), WT1 and FLT3-ITD aberrations were independent risk factors for poor overall survival (HR = 2·32, P = 0·038 and HR = 1·89, P = 0·045 respectively). These data show that molecular aberrations at first relapse are of prognostic relevance and potentially useful for risk group stratification of paediatric relapsed AML and for identification of patients eligible for personalized treatment.
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Affiliation(s)
- Costa Bachas
- Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands; Department of Paediatric Oncology/Haematology, VU University Medical Centre, Amsterdam, The Netherlands
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Faulk K, Gore L, Cooper T. Overview of therapy and strategies for optimizing outcomes in de novo pediatric acute myeloid leukemia. Paediatr Drugs 2014; 16:213-27. [PMID: 24639021 DOI: 10.1007/s40272-014-0067-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although acute myelogenous leukemia (AML) accounts for <20 % of leukemia in children, it is responsible for over half of all pediatric leukemia deaths. Improvement in event-free survival rates, now over 50 %, are due largely to intensification of chemotherapy, aggressive supportive care, development of risk stratification based on cytogenetic and molecular markers, and improved salvage regimens. Despite this improvement over the past few decades, the survival rates have recently plateaued, and further improvement will need to take into account advances in molecular characterization of AML, development of novel agents, and better understanding of host factors influencing toxicity and response to chemotherapy. This article reviews the epidemiology and biology trends in diagnosis and treatment of pediatric acute myelogenous leukemia.
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Affiliation(s)
- Kelly Faulk
- Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora, CO, USA
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Hu S, Wang Y, Wu S, Zhang M, Pan J, Shen H, Qi X, Cen J, Chen Z, Shen B, Chen R. Homology modeling and molecular dynamics studies of Wilms' tumor gene 1 frameshift mutations in exon 7. Biomed Rep 2014; 1:702-706. [PMID: 24649013 DOI: 10.3892/br.2013.149] [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: 05/22/2013] [Accepted: 07/03/2013] [Indexed: 11/05/2022] Open
Abstract
As a transcription factor, the Wilms' tumor 1 (WT1) gene plays an important role in leukemogenesis. The impact of WT1 gene mutations has been reported in acute myeloid leukemia (AML). However, the number of available studies on the spatial configuration changes following WT1 mutation is limited. In this study, we sequenced the mutation in exon 7 of the WT1 gene in 60 children with newly diagnosed AML and the spatial configuration of WT1 with frameshift mutations in exon 7 was evaluated using the software for homology modeling and optimization of molecular dynamics. Three cases with frameshift mutations in exon 7 were identified (3/60; mutation rate, 5%). One case had a mutation that had been previously described, whereas the remaining two mutations were first described in our study. Of the three cases, one case presented with antecedent myelodysplastic syndrome (MDS) and the remaining two cases exhibited primary resistance to induction chemotherapy. The spatial configuration analysis demonstrated that the three mutations affected the spatial structure of exon 7 and even affected exon 8 compared to its wild-type. This study demonstrated that the frameshift mutation in exon 7 of the WT1 gene is a poor prognostic factor for children with AML, partly through the spatial configuration changes following frameshift mutations of WT1, which highlights the structure-based function analysis and may facilitate the elucidation of the pathogenesis underlying WT1 gene mutations.
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Affiliation(s)
- Shaoyan Hu
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, P.R. China
| | - Ying Wang
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, P.R. China
| | - Shuiyan Wu
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, P.R. China
| | - Mingying Zhang
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, P.R. China
| | - Jian Pan
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, P.R. China
| | - Hongjie Shen
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Xiaofei Qi
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Jiannong Cen
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Zixing Chen
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Bairong Shen
- Center for Systems Biology, Soochow University, Suzhou, Jiangsu, P.R. China
| | - Ruihua Chen
- Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Rizzari C, Cazzaniga G, Coliva T, De Angelis C, Conter V. Predictive factors of relapse and survival in childhood acute myeloid leukemia: role of minimal residual disease. Expert Rev Anticancer Ther 2014; 11:1391-401. [DOI: 10.1586/era.11.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Zidan MAA, Kamal Shaaban HM, Elghannam DM. Prognostic impact of Wilms tumor gene mutations in Egyptian patients with acute myeloid leukemia with normal karyotype. ACTA ACUST UNITED AC 2013; 19:267-74. [PMID: 24074521 DOI: 10.1179/1607845413y.0000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
The Wilms' tumor (WT1) gene mutations were detected in patients with most forms of acute leukemia. However, the biological significance and the prognostic impact of WT1 mutation in Egyptian patients with acute myeloid leukemia with normal karyotype (AML-NK) are still uncertain. We aimed to evaluate the incidence and clinical relevance of WT1 gene mutations in acute myeloid leukemia with normal karyotype (AML-NK). Exons 7 and 9 of WT1 were screened in samples from 216 adult NK-AML using polymerase chain reaction single-strand conformation polymorphism techniques. Twenty-three patients (10.6%) harbored WT1 mutations. Younger ages and higher marrow blasts were significantly associated with WT1 mutations (P = 0.006 and 0.003 respectively). Complete remission rates were significantly lower in patients with WT1 mutations than those with WT1 wild-type (P = 0.015). Resistance, relapse, and mortality rates were significantly higher in patients with WT1 mutations than those without (P = 0.041, 0.016, and 0.008 respectively). WT1 mutations were inversely associated with NPM1 mutations (P = 0.007). Patients with WT1 mutations had worse disease-free survival (P < 0.001) and overall survival (P < 0.001) than patients with WT1 wild-type. In multivariable analyses, WT1 mutations independently predicted worse DFS (P < 0.001; hazard ratio [HR] 0.036) and overall survival (P = 0.001; HR = 0.376) when controlling for age, total leukocytic count (TLC), and NPM1 mutational status. In conclusion, WT1 mutations are a negative prognostic indicator in intensively treated patients with AML-NK, may be a part of molecularly based risk assessment and risk-adapted treatment stratification of patients with AML-NK.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Case-Control Studies
- Egypt
- Exons
- Female
- Gene Frequency
- Genes, Wilms Tumor
- Humans
- Karyotype
- Karyotyping
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mutation
- Nuclear Proteins/genetics
- Nucleophosmin
- Polymorphism, Single-Stranded Conformational
- Prognosis
- Remission Induction
- Treatment Outcome
- Young Adult
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Zeijlemaker W, Gratama JW, Schuurhuis GJ. Tumor heterogeneity makes AML a "moving target" for detection of residual disease. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 86:3-14. [PMID: 24151248 DOI: 10.1002/cyto.b.21134] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/26/2013] [Accepted: 09/17/2013] [Indexed: 12/24/2022]
Abstract
Detection of minimal residual disease is recognized as an important post-therapy risk factor in acute myeloid leukemia patients. Two most commonly used methods for residual disease monitoring are real-time quantitative polymerase chain reaction and multiparameter flow cytometry. The results so far are very promising, whereby it is likely that minimal residual disease results will enable to guide future post-remission treatment strategies. However, the leukemic clone may change between diagnosis and relapse due to the instability of the tumor cells. This instability may already be evident at diagnosis if different subpopulations of tumor cells coexist. Such tumor heterogeneity, which may be reflected by immunophenotypic, molecular, and/or cytogenetic changes, can have important consequences for minimal residual disease detection, since false-negative results can be expected to be the result of losses of aberrancies used as minimal residual disease markers. In this review the role of such changes in minimal residual disease monitoring is explored. Furthermore, possible causes of tumor instability are discussed, whereby the concept of clonal selection and expansion of a chemotherapy-resistant subpopulation is highlighted. Accordingly, detailed knowledge of the process of clonal evolution is required to improve both minimal residual disease risk stratification and patient outcome.
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MESH Headings
- Adult
- Biomarkers, Tumor
- Clonal Evolution
- Drug Resistance, Neoplasm/genetics
- Flow Cytometry
- Genetic Variation
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/prevention & control
- Real-Time Polymerase Chain Reaction
- Treatment Outcome
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Affiliation(s)
- W Zeijlemaker
- Department of Hematology, VU Institute for Cancer and Immunology (V-ICI), VU University Medical Center, Amsterdam, The Netherlands
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Leukemia associated mutant Wilms’ tumor gene 1 protein promotes expansion of human hematopoietic progenitor cells. Leuk Res 2013; 37:1341-9. [DOI: 10.1016/j.leukres.2013.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/03/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022]
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Sano H, Shimada A, Tabuchi K, Taki T, Murata C, Park MJ, Ohki K, Sotomatsu M, Adachi S, Tawa A, Kobayashi R, Horibe K, Tsuchida M, Hanada R, Tsukimoto I, Hayashi Y. WT1 mutation in pediatric patients with acute myeloid leukemia: a report from the Japanese Childhood AML Cooperative Study Group. Int J Hematol 2013; 98:437-45. [PMID: 23979985 DOI: 10.1007/s12185-013-1409-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/29/2013] [Accepted: 08/06/2013] [Indexed: 01/18/2023]
Abstract
Mutations in Wilms tumor 1 (WT1) have been reported in 10-22 % of patients with cytogenetically normal acute myeloid leukemia (CN-AML), but the prognostic implications of these abnormalities have not been clarified in either adults or children. One hundred and fifty-seven pediatric AML patients were analyzed for WT1 mutations around hotspots at exons 7 and 9; however, amplification of the WT1 gene by the reverse transcriptase-polymerase chain reaction was not completed in four cases (2.5 %). Of the 153 evaluable patients, 10 patients (6.5 %) had a mutation in WT1. The incidence of WT1 mutations was significantly higher in CN-AML than in others (15.2 vs. 4.5 %, respectively, P = 0.03). Of the 10 WT1-mutated cases, eight (80 %) had mutations in other genes, including FLT3-ITD in two cases, FLT3-D835 mutation in two, KIT mutation in three, MLL-PTD in three, NRAS mutation in one, and KRAS mutation in two (in some cases, more than one additional gene was mutated). The incidences of KIT and FLT3-D835 mutations were significantly higher in patients with than in those without WT1 mutation. No significant differences were observed in the 3-year overall survival and disease-free survival; however, the presence of WT1 mutation was related to a poor prognosis in patients with CN-AML, excluding those with FLT3-ITD and those younger than 3 years.
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Affiliation(s)
- Hirozumi Sano
- Department of Hematology/Oncology, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsu, Shibukawa, Gunma, 377-8577, Japan
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Affiliation(s)
- Paula Marlton
- Department of Haematology, Princess Alexandra Hospital , Brisbane , Australia
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Abstract
Mutations in the Wilms tumor suppressor 1 (WT1) gene are as frequent in acute myeloid leukemia (AML) as in nephroblastma and predict poor prognosis. However, the role of WT1 in hematopoiesis remains unclear. We show that Wt1-deficient mouse embryonic stem cells exhibit reduced hematopoietic potential caused by vascular endothelial growth factor A (Vegf-a)-dependent apoptosis of hematopoietic progenitor cells associated with overproduction of the Vegf-a120 isoform. We demonstrate that Wt1 promotes exon inclusion using a Vegf-a minigene-based splicing assay. These data identify a critical role for Wt1 in hematopoiesis and Vegf-a as a cellular RNA whose splicing is potentially regulated by Wt1. The correction of Wt1 deficiency by treatment with exogenous Vegf-a protein indicates that the Wt1/Vegf-a axis is a molecular pathway that could be exploited for the management/treatment of poor prognosis AMLs.
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Single nucleotide polymorphisms in the Wilms' tumour gene 1 in clear cell renal cell carcinoma. PLoS One 2013; 8:e58396. [PMID: 23484026 PMCID: PMC3590177 DOI: 10.1371/journal.pone.0058396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 02/04/2013] [Indexed: 11/19/2022] Open
Abstract
The Wilms' tumour gene 1 (WT1) single nucleotide polymorphism (SNP) rs16754 has recently been described as an independent prognostic factor in acute myeloid leukaemia (AML) patients. It is of great interest to test whether WT1 SNPs can be used as a molecular marker in other cancer types in order to improve risk and treatment stratification. We performed sequencing analysis on all 10 exons of the WT1 gene in a total of 182 patients with clear cell renal cell carcinoma (ccRCC). Six different SNPs were identified, in descending order for minor allele frequency: rs2234582, rs16754, rs1799925, rs5030315, rs2234583, and rs2234581. At least one minor allele for WT1 SNP was identified in 61% of ccRCC patients. In the entire study population, only 6% carried two copies of the minor allele. The genotypes of WT1 SNPs in 78 tumour-free kidney tissue specimens were found to be in 95% concordance with corresponding tumour samples. No correlation was observed between WT1 SNP genotypes and RNA expression level. WT1 SNP genotypes did not associate with clinical and pathological characteristics. We found favourable outcomes associated with the homozygous minor allele for WT1 SNP. However, SNP genotypes did not show to be of prognostic significance when comparing wild-type versus homozygous or heterozygous for the minor allele in the entire cohort. None of the previously reported WT1 mutations in AML was found in the present study. A novel WT1 missense mutation was identified in only one patient. Our data suggest that common WT1 mutations are not involved in ccRCC. Due to too few cases harbouring the homozygous minor allele, the prognostic impact needs to be verified in larger study populations.
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Bai J, Guo A, Hong Z, Kuai W. Upregulation of microRNA-100 predicts poor prognosis in patients with pediatric acute myeloid leukemia. Onco Targets Ther 2012; 5:213-9. [PMID: 23055746 PMCID: PMC3457676 DOI: 10.2147/ott.s36017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Indexed: 11/23/2022] Open
Abstract
Objective: MicroRNA-100 (miR-100), a small noncoding RNA molecule, acts as a tumor suppressor or an oncogene in different cancers. The aberrant expression of this microRNA has been demonstrated as a frequent event in adult patients with acute myeloid leukemia (AML), but little is known for pediatric AML. The aim of this study was to investigate the expression and clinical significance of miR-100 in pediatric AML. Methods: The expression levels of miR-100 in bone marrow mononuclear cells were detected by real-time quantitative polymerase chain reaction in a cohort of 106 patients with de novo pediatric AML. The prognostic values of miR-100 in pediatric AML were also analyzed. Results: Compared with normal controls, upregulation of miR-100 in the bone marrow of pediatric AML patients with statistically significant differences (P < 0.001) was found. The expression levels of miR-100 were found to be significantly higher in pediatric AML patients with extramedullary disease, with the French–American–British classification subtype M7, and with unfavorable day 7 response to induction chemotherapy (P = 0.008, 0.001 and 0.01, respectively). Moreover, both univariate and multivariate analyses revealed that miR-100 upregulation was associated with poorer relapse-free and overall survival in pediatric AML patients. Conclusion: This is the first report demonstrating the upregulation of miR-100 in pediatric AML, and its association with poor relapse-free and overall survival. These results suggest that miR-100 upregulation may be used as an unfavorable prognostic marker in pediatric AML.
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Affiliation(s)
- Jin Bai
- Department of Pediatrics, Huai'an Hospital to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, China
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