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The Cytogenetic Landscape of Pediatric Chronic Myeloid Leukemia Diagnosed in Chronic Phase. Cancers (Basel) 2022; 14:cancers14071712. [PMID: 35406484 PMCID: PMC8997049 DOI: 10.3390/cancers14071712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Philadelphia chromosome-positive chronic myeloid leukemia (CML) is characterized by the translocation of the chromosomes 9 and 22. Additional non-Philadelphia aberrations of chromosomes (nPhAs) and their prognostic relevance for the disease course are comparably well known in adult patients with CML. However, due to the rarity of CML in children and adolescents, nPhAs have hardly been determined systematically in these age groups. Here, we present a large analysis of nPhAs detected in a cohort of 161 patients younger than 18 years who had been diagnosed with CML in chronic phase and enrolled in the German national CML-PAED-II registry. We found a distinct distribution of nPhAs in this pediatric cohort with possible impact on treatment response whereas the survival remained unaffected. Our findings emphasize differences in the disease biology between pediatric and adult patients and prompt further joint international efforts to acquire more data on the disease in this age group. Abstract Philadelphia chromosome-positive chronic myeloid leukemia (CML) is cytogenetically characterized by the classic translocation t(9;22)(q34;q11), whereas additional non-Philadelphia aberrations (nPhAs) have been studied extensively in adult patients with CML, knowledge on nPhAs in pediatric patients with CML is still sparse. Here, we have determined nPhAs in a cohort of 161 patients younger than 18 years diagnosed with chronic phase CML and consecutively enrolled in the German national CML-PAED-II registry. In 150 cases (93%), an informative cytogenetic analysis had been performed at diagnosis. In total, 21 individuals (13%) showed nPhAs. Of these, 12 (8%) had a variant translocation, 4 (3%) additional chromosomal aberrations (ACAs) and 5 (3%) harbored a complex karyotype. Chromosome 15 was recurrently involved in variant translocations. No significant impact of the cytogenetic subgroup on the time point of cytogenetic response was observed. Patients with a complex karyotype showed an inferior molecular response compared to patients carrying the classic translocation t(9;22)(q34;q11), variant translocations or ACAs. No significant differences in the probability of progression-free survival and overall survival was found between patients with nPhAs and patients with the classic Philadelphia translocation only. Our results highlight the distinct biology of pediatric CML and underline the need for joint international efforts to acquire more data on the disease pathogenesis in this age group.
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Cayssials E, Guilhot F. The -7 chromosomal abnormalities with signs of myelodysplasia in chronic myeloid leukemia as a major red signal. Haematologica 2019; 104:1096-1098. [PMID: 31152086 PMCID: PMC6545827 DOI: 10.3324/haematol.2019.217034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Emilie Cayssials
- Inserm CIC 1402, University Hospital of Poitiers, CHU de Poitiers, France
| | - François Guilhot
- Inserm CIC 1402, University Hospital of Poitiers, CHU de Poitiers, France
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Saglio G, Jabbour E. First-line therapy for chronic phase CML: selecting the optimal BCR-ABL1-targeted TKI. Leuk Lymphoma 2017; 59:1523-1538. [PMID: 28972424 DOI: 10.1080/10428194.2017.1379074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients diagnosed with chronic myeloid leukemia (CML) and treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs) have long life spans. Selection of an appropriate first-line therapy can be difficult as both the unique characteristics of each TKI and patient need to be taken into account to find the optimal match. Patient characteristics include comorbidities, concomitant medications, lifestyle, risk factors, BCR-ABL1 transcript type (e.g. b2a2 or b3a2) and additional chromosomal abnormalities. Just as patients differ, side effects, drug-drug interactions, administration plans, dosing schedules and treatment-related expenses across TKIs also vary. Alignment of these characteristics with the appropriate TKI is key to successfully initiating CML treatment. Continued success relies on communication between the patient and the healthcare team, adherence and optimization of therapy once it is initiated. In this review, we discuss these factors, in addition to TKI efficacy and safety, the cost of therapy, the future of treating CML and treatment-free remission.
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Affiliation(s)
- Giuseppe Saglio
- a Clinical and Biological Sciences of the University of Turin, San Luigi Hospital , Orbassano-Torino , Italy
| | - Elias Jabbour
- b Department of Leukemia, Division of Cancer Medicine , The University of Texas MD Anderson Cancer Center , Houston , Texas
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Chauffaille MDLLF. Is karyotyping still needed in the diagnosis and monitoring of chronic myeloid leukemia? Rev Bras Hematol Hemoter 2017; 39:281-282. [PMID: 28830611 PMCID: PMC5568583 DOI: 10.1016/j.bjhh.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 11/29/2022] Open
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Millot F, Dupraz C, Guilhot J, Suttorp M, Brizard F, Leblanc T, Güneş AM, Sedlacek P, De Bont E, Li CK, Kalwak K, Lausen B, Culic S, Dworzak M, Kaiserova E, De Moerloose B, Roula F, Biondi A, Baruchel A, Guilhot F. Additional cytogenetic abnormalities and variant t(9;22) at the diagnosis of childhood chronic myeloid leukemia: The experience of the International Registry for Chronic Myeloid Leukemia in Children and Adolescents. Cancer 2017; 123:3609-3616. [PMID: 28497898 DOI: 10.1002/cncr.30767] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the adult population with newly diagnosed chronic myeloid leukemia (CML), variant translocations are usually not considered to be impairing the prognosis, whereas some additional cytogenetic abnormalities (ACAs) are associated with a negative impact on survival. Because of the rarity of CML in the pediatric population, such abnormalities have not been investigated in a large group of children with CML. METHODS The prognostic relevance of variant t(9;22) and ACAs at diagnosis was assessed in 301 children with CML in the chronic phase who were enrolled in the International Registry for Chronic Myeloid Leukemia in Children and Adolescents. RESULTS Overall, 19 children (6.3%) presented with additional cytogenetic findings at diagnosis: 5 children (1.7%) had a variant t(9;22) translocation, 13 children (4.3%) had ACAs, and 1 had both. At 3 years, for children with a classic translocation, children with ACAs, and children with a variant t(9;22) translocation who were treated with imatinib as frontline therapy, the probability of progression-free survival (PFS) was 95% (95% confidence interval [CI], 91%-97%), 100%, and 75% (95% CI, 13%-96%), respectively, and the probability of overall survival (OS) was 98% (95% CI, 95%-100%), 100% (95% CI, 43%-98%), and 75% (95% CI, 13%-96%), respectively. No statistical difference was observed between the patients with classic cytogenetic findings and those with additional chromosomal abnormalities in terms of PFS and OS. CONCLUSIONS In contrast to adults with CML, additional chromosomal abnormalities observed at diagnosis do not seem to have a significant prognostic impact. Cancer 2017;123:3609-16. © 2017 American Cancer Society.
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Affiliation(s)
- Frédéric Millot
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Christelle Dupraz
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Joelle Guilhot
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Meinolf Suttorp
- Department of Pediatrics, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Françoise Brizard
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Thierry Leblanc
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - Adalet Meral Güneş
- Department of Pediatric Hematology, Uludağ University Hospital, Görükle Bursa, Turkey
| | - Petr Sedlacek
- Department of Pediatric Hematology-Oncology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Evelyne De Bont
- Department of Pediatric Oncology-Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Dutch Childhood Oncology Group, the Hague, the Netherlands
| | - Chi Kong Li
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Krzysztof Kalwak
- Department of Pediatric Hematology-Oncology and Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Birgitte Lausen
- Department of Pediatrics, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Srdjana Culic
- Department of Pediatric Hematology, Oncology, Immunology, and Medical Genetics, Clinical Hospital, Split, Croatia
| | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Vienna, Austria
| | - Emilia Kaiserova
- Department of Pediatric Oncology, University Children's Hospital, Bratislava, Slovakia
| | | | - Farah Roula
- Department of Pediatrics, Saint George Hospital University Medical Centre, Beirut, Lebanon
| | - Andrea Biondi
- Department of Pediatrics, San Gerardo Hospital, University of Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - André Baruchel
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - François Guilhot
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
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