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Guijarro F, Castaño-Díez S, Jiménez-Vicente C, Garrote M, Álamo JR, Gómez-Hernando M, López-Oreja I, Morata J, López-Guerra M, López C, Beà S, Costa D, Colomer D, Díaz-Beyá M, Rozman M, Esteve J. Whole Exome Sequencing of Intermediate-Risk Acute Myeloid Leukemia without Recurrent Genetic Abnormalities Offers Deeper Insights into New Diagnostic Classifications. Int J Mol Sci 2024; 25:8669. [PMID: 39201354 PMCID: PMC11354381 DOI: 10.3390/ijms25168669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Two new diagnostic classifications of acute myeloid leukemia (AML) were published in 2022 to update current knowledge on disease biology. In previous 2017-edition categories of AML with myelodysplasia-related changes, AML was not otherwise specified, but AML with mutated RUNX1 experienced profound changes. We performed whole exome sequencing on a cohort of 69 patients with cytogenetic intermediate-risk AML that belonged to these diagnostic categories to correlate their mutational pattern and copy-number alterations with their new diagnostic distribution. Our results show that 45% of patients changed their diagnostic category, being AML myelodysplasia-related the most enlarged, mainly due to a high frequency of myelodysplasia-related mutations (58% of patients). These showed a good correlation with multilineage dysplasia and/or myelodysplastic syndrome history, but at the same time, 21% of de novo patients without dysplasia also presented them. RUNX1 was the most frequently mutated gene, with a high co-occurrence rate with other myelodysplasia-related mutations. We found a high prevalence of copy-neutral loss of heterozygosity, frequently inducing a homozygous state in particular mutated genes. Mild differences in current classifications explain the diagnostic disparity in 10% of patients, claiming a forthcoming unified classification.
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Affiliation(s)
- Francesca Guijarro
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - Sandra Castaño-Díez
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - Carlos Jiménez-Vicente
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Marta Garrote
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - José Ramón Álamo
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - Marta Gómez-Hernando
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - Irene López-Oreja
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - Jordi Morata
- Centro Nacional de Análisis Genómico (CNAG), 08028 Barcelona, Spain;
| | - Mònica López-Guerra
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Biomedical Research Networking Center on Oncology (CIBERONC), 28029 Madrid, Spain
| | - Cristina López
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Biomedical Research Networking Center on Oncology (CIBERONC), 28029 Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Sílvia Beà
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Biomedical Research Networking Center on Oncology (CIBERONC), 28029 Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Dolors Costa
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Biomedical Research Networking Center on Oncology (CIBERONC), 28029 Madrid, Spain
| | - Dolors Colomer
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Biomedical Research Networking Center on Oncology (CIBERONC), 28029 Madrid, Spain
| | - Marina Díaz-Beyá
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Maria Rozman
- Hematopathology Section, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (M.G.); (J.R.Á.); (M.G.-H.); (I.L.-O.); (M.L.-G.); (C.L.); (S.B.); (D.C.); (D.C.); (M.R.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
| | - Jordi Esteve
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (C.J.-V.); (M.D.-B.); (J.E.)
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Facultat de Medicina, Universitat de Barcelona, 08007 Barcelona, Spain
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Winters AC, Minhajuddin M, Stevens BM, Major A, Bosma G, Abbott D, Miltgen N, Yuan J, Treece AL, Siegele BJ, Ewalt MD, Gutman JA, Jordan CT, Pollyea DA. Multi-gene measurable residual disease assessed by digital polymerase chain reaction has clinical and biological utility in acute myeloid leukemia patients receiving venetoclax/azacitidine. Haematologica 2024; 109:1766-1778. [PMID: 38105738 PMCID: PMC11141685 DOI: 10.3324/haematol.2023.283790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
Venetoclax with azacitidine (ven/aza) is a lower-intensity therapeutic regimen that has been shown to improve outcomes in elderly patients with acute myeloid leukemia (AML). Measurable residual disease (MRD) using flow cytometry is a valuable tool for the prediction of relapse in AML using conventional therapies and ven/aza; however, the prognostic value for broadscale molecular MRD after ven/aza treatment is less clear. We aimed to determine the utility of retrospective assessment using multi-gene molecular MRD by droplet digital polymerase chain reaction (ddPCR). We found this approach correlates with outcomes in a cohort of patients receiving frontline ven/aza for AML. The predictive value of ddPCR MRD persisted when NPM1 mutations were removed from analysis, as well as after adjustment for the impact of stem cell transplant on outcomes. Late achievement of MRD negativity, including after SCT, was still associated with superior outcomes compared to persistently detectable MRD. We further explored the impact of ven/aza on the burden of different classes of mutations, and identified the persistence of splicing factor mutations, commonly associated with MDS, as a consistent finding after ven/aza treatment. These data add to our understanding of the effects of ven/aza on AML disease biology and provide details on molecular depth of remission that can guide prospective trials in the future.
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MESH Headings
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myeloid, Acute/diagnosis
- Neoplasm, Residual/diagnosis
- Nucleophosmin
- Sulfonamides/therapeutic use
- Sulfonamides/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Aged
- Male
- Female
- Azacitidine/therapeutic use
- Azacitidine/administration & dosage
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Mutation
- Polymerase Chain Reaction/methods
- Prognosis
- Aged, 80 and over
- Retrospective Studies
- Adult
- Treatment Outcome
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Affiliation(s)
- Amanda C Winters
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado, Aurora.
| | - Mohd Minhajuddin
- Division of Hematology, Department of Medicine, University of Colorado, Aurora
| | - Brett M Stevens
- Division of Hematology, Department of Medicine, University of Colorado, Aurora
| | - Ajay Major
- Division of Hematology, Department of Medicine, University of Colorado, Aurora
| | - Grace Bosma
- Department of Biostatistics and Informatics, University of Colorado, Aurora
| | - Diana Abbott
- Department of Biostatistics and Informatics, University of Colorado, Aurora
| | | | - Ji Yuan
- Molecular Diagnostics, Children's Hospital Colorado, Aurora
| | - Amy L Treece
- Pediatric Pathology, Children's of Alabama, Birmingham
| | | | - Mark D Ewalt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Jonathan A Gutman
- Division of Hematology, Department of Medicine, University of Colorado, Aurora
| | - Craig T Jordan
- Division of Hematology, Department of Medicine, University of Colorado, Aurora
| | - Daniel A Pollyea
- Division of Hematology, Department of Medicine, University of Colorado, Aurora
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Wang LY, Li Y, Jiang Q, Jiang H, Wang Y, Xu LP, Zhang XH, Liu KY, Tang FF. Clinical characteristics and prognosis of acute myeloid leukemia patients with Runt-related transcription factor 1 mutation: A single-center retrospective analysis. Hematol Oncol 2024; 42:e3256. [PMID: 38367260 DOI: 10.1002/hon.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
This study aimed to investigate the clinical characteristics and prognosis of Runt-related transcription factor 1 (RUNX1) mutant acute myeloid leukemia (AML) patients by comparing the features of AML patients with or without RUNX1 mutation. We retrospectively analyzed 180 AML patients including 36 AML patients with mutant RUNX1(AML-RUNX1mut ) and 144 AML patients with wild-type RUNX1(AML-RUNX1wt ) were selected using the case-pair method(1:4). Compared to AML-RUNX1wt , AML-RUNX1mut showed higher frequency of ASXL1 (p < 0.001), SRSF2 (p < 0.001), BCORL1 (p < 0.001), RAS (p = 0.010) mutations, and absent NPM1 mutations (p = 0.022). The 3-year overall survival (OS) and disease-free survival (DFS) of AML-RUNX1mut and AML-RUNX1wt were 73.1% versus 68.0% (p = 0.64) and 80.7% versus 71.6% (p = 0.37), respectively. AML-RUNX1mut receiving allogeneic hematopoietic cell transplantation (allo-HSCT) showed better survival than those who did not receive allo-HSCT (3-year OS, 84.3% vs. 52.7%; p = 0.006). Multivariate analysis showed that EZH2 mutation (p = 0.003), white blood cell (WBC) ≥30 × 109 /L (p = 0.036) and age ≥60 years (p = 0.038) were significant independent risk factors for inferior OS of AML-RUNX1mut ; WBC ≥30 × 109 /L (p = 0.013) and DNMT3A mutation (p = 0.045) were significant independent risk factors for shorter DFS of AML-RUNX1mut . In conclusion, AML-RUNX1mut showed unique clinical characteristics, but the survival between AML-RUNX1mut and AML-RUNX1wt were comparable. EZH2 co-mutation, DNMT3A co-mutation, old age and high WBC count were associated with inferior survival of AML-RUNX1mut . Allo-HSCT can significantly improve the prognosis of AML-RUNX1mut .
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Affiliation(s)
- Lin-Ya Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yao Li
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Hao Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Fei-Fei Tang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
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Wachter F, Pikman Y. Pathophysiology of Acute Myeloid Leukemia. Acta Haematol 2024; 147:229-246. [PMID: 38228114 DOI: 10.1159/000536152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a biologically heterogenous disease arising in clonally proliferating hematopoietic stem cells. Sequential acquisition of mutations leads to expanded proliferation of clonal myeloid progenitors and failure of differentiation, leading to fulminant AML. SUMMARY Here, we review the pathophysiology of AML with a focus on factors predisposing to AML development, including prior chemo- and radiation therapy, environmental factors, and germline predisposition. KEY MESSAGE Increasing genomic characterization of AML and insight into mechanisms of its development will be critical to improvement in AML prognostication and therapy.
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Affiliation(s)
- Franziska Wachter
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yana Pikman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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Zheng R, Fuda F, Gagan JR, Weinberg OK, Koduru P, Cantu M, Ludwig K, Truscott JM, Collins R, Chung S, Madanat YF, Chen W. Genomic heterogeneity within B/T mixed phenotype acute leukemia in a context of an immunophenotype. Leuk Res Rep 2023; 21:100410. [PMID: 38273970 PMCID: PMC10808966 DOI: 10.1016/j.lrr.2023.100410] [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: 06/24/2023] [Revised: 11/19/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
B/T mixed phenotype acute leukemia (MPAL) is a rare aggressive leukemia. Three cases of B/T MPAL were identified with comprehensive immunophenotypic, cytogenetic, and molecular studies. T-lineage predominant B/T MPAL shares a genetic signature with T-ALL whereas B/T lineage co-dominant B/T MPAL lacks such a T-ALL signature. All three patients were treated with lineage-matched-ALL therapy and alive at the last follow-up. Our study is the first to demonstrate molecular heterogeneity within B/T MPAL in a context of an immunophenotype of T-lineage versus B-lineage predominance. The implication of such a phenotype-genotype association on diagnostic classification is briefly discussed.
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Affiliation(s)
- Ruifang Zheng
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Franklin Fuda
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeffrey R. Gagan
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Olga K. Weinberg
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Prasad Koduru
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Miguel Cantu
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kathleen Ludwig
- Departments of Pediatrics (Hematology and Oncology), University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jamie M. Truscott
- Departments of Pediatrics (Hematology and Oncology), University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Robert Collins
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Stephen Chung
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yazan F. Madanat
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Weina Chen
- Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Galera P, Dilip D, Derkach A, Chan A, Zhang Y, Persuad S, Mishera T, Liu Y, Famulare C, Gao Q, Mata DA, Arcila M, Geyer MB, Stein E, Dogan A, Levine RL, Roshal M, Glass J, Xiao W. Acute myeloid leukemia with mixed phenotype is characterized by stemness transcriptomic signatures and limited lineage plasticity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.01.23297696. [PMID: 37961275 PMCID: PMC10635245 DOI: 10.1101/2023.11.01.23297696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Mixed phenotype (MP) in acute leukemias poses unique classification and management dilemmas and can be seen in entities other than de novo mixed phenotype acute leukemia (MPAL). Although WHO classification empirically recommends excluding AML with myelodysplasia related changes (AML-MRC) and therapy related AML (t-AML) with mixed phenotype (AML-MP) from MPAL, there is lack of studies investigating the clinical, genetic, and biologic features of AML-MP. We report the first cohort of AML-MRC and t-AML with MP integrating their clinical, immunophenotypic, genomic and transcriptomic features with comparison to MPAL and AML-MRC/t-AML without MP. Both AML cohorts with and without MP shared similar clinical features including adverse outcomes but were different from MPAL. The genomic landscape of AML-MP overlaps with AML without MP but differs from MPAL. AML-MP harbors more frequent RUNX1 mutations than AML without MP and MPAL. RUNX1 mutations did not impact the survival of patients with MPAL. Unsupervised hierarchal clustering based on immunophenotype identified biologically distinct clusters with phenotype/genotype correlation and outcome differences. Furthermore, transcriptomic analysis showed an enrichment for stemness signature in AML-MP and AML without MP as compared to MPAL. Lastly, MPAL but not AML-MP often switched to lymphoid only immunophenotype after treatment. Expression of transcription factors critical for lymphoid differentiation were upregulated only in MPAL, but not in AML-MP. Our study for the first time demonstrates that AML-MP clinically and biologically resembles its AML counterpart without MP and differs from MPAL, supporting the recommendation to exclude these patients from the diagnosis of MPAL. Future studies are needed to elucidate the molecular mechanism of mixed phenotype in AML. Key points AML-MP clinically and biologically resembles AML but differs from MPAL. AML-MP shows RUNX1 mutations, stemness signatures and limited lymphoid lineage plasticity.
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7
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Hochman MJ, Othus M, Hasserjian RP, Ambinder A, Brunner A, Percival MEM, Hourigan CS, Swords R, DeZern AE, Estey EH, Karp JE. Prognostic impact of secondary versus de novo ontogeny in acute myeloid leukemia is accounted for by the European LeukemiaNet 2022 risk classification. Leukemia 2023; 37:1915-1918. [PMID: 37524919 PMCID: PMC10457181 DOI: 10.1038/s41375-023-01985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
Secondary AML (sAML), defined by either history of antecedent hematologic disease (AHD) or prior genotoxic therapy (tAML), is classically regarded as having worse prognosis than de novo disease (dnAML). Clinicians may infer a new AML diagnosis is secondary based on a history of antecedent blood count (ABC) abnormalities in the absence of known prior AHD, but whether abnormal ABCs are associated with worse outcomes is unclear. Secondary-type mutations have recently been incorporated into the European LeukemiaNet (ELN) 2022 guidelines as adverse-risk features, raising the question of whether clinical descriptors of ontogeny (i.e., de novo or secondary) are prognostically significant when accounting for genetic risk by ELN 2022. In a large multicenter cohort of patients (n = 734), we found that abnormal ABCs are not independently prognostic after adjusting for genetic characteristics in dnAML patients. Furthermore, history of AHD and tAML do not confer increased risk of death compared to dnAML on multivariate analysis, suggesting the prognostic impact of ontogeny is accounted for by disease genetics as stratified by ELN 2022 risk and TP53 mutation status. These findings emphasize the importance that disease genetics should play in risk stratification and clinical trial eligibility in AML.
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Affiliation(s)
- Michael J Hochman
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Alex Ambinder
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew Brunner
- Leukemia Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christopher S Hourigan
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ronan Swords
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Amy E DeZern
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Elihu H Estey
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Judith E Karp
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
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8
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Sun S, Han Y, Lei Y, Yu Y, Dong Y, Chen J. Hematopoietic Stem Cell: Regulation and Nutritional Intervention. Nutrients 2023; 15:nu15112605. [PMID: 37299568 DOI: 10.3390/nu15112605] [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: 05/08/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Hematopoietic stem cells (HSCs) are crucial for the life maintenance of bio-organisms. However, the mechanism of HSC regulation is intricate. Studies have shown that there are various factors, either intrinsically or extrinsically, that shape the profile of HSCs. This review systematically summarizes the intrinsic factors (i.e., RNA-binding protein, modulators in epigenetics and enhancer-promotor-mediated transcription) that are reported to play a pivotal role in the function of HSCs, therapies for bone marrow transplantation, and the relationship between HSCs and autoimmune diseases. It also demonstrates the current studies on the effects of high-fat diets and nutrients (i.e., vitamins, amino acids, probiotics and prebiotics) on regulating HSCs, providing a deep insight into the future HSC research.
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Affiliation(s)
- Siyuan Sun
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100190, China
| | - Yingxue Han
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics and Breeding of the Ministry of Agriculture, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
| | - Yumei Lei
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100190, China
| | - Yifei Yu
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100190, China
| | - Yanbin Dong
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100045, China
| | - Juan Chen
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100190, China
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