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Geyer MB, Shaffer BC, Bhatnagar B, Mims AS, Klein V, Dilip D, Glass JL, Lozanski G, Hassoun H, Landau H, Zhang Y, Xiao W, Roshal M, Park JH. Lenalidomide-associated B-cell ALL: clinical and pathologic correlates and sensitivity to lenalidomide withdrawal. Blood Adv 2023; 7:3087-3098. [PMID: 36827680 PMCID: PMC10362546 DOI: 10.1182/bloodadvances.2022009212] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023] Open
Abstract
Lenalidomide is an effective component of induction and maintenance therapy for multiple myeloma, though with a risk of secondary malignancies, including acute lymphoblastic leukemia (ALL). In contrast to therapy-related myeloid neoplasia, lenalidomide-associated lymphoblastic neoplasia remains poorly characterized. We conducted a dual institution retrospective study of 32 ALL cases that arose after lenalidomide maintenance (all B-lineage, 31/32 BCR::ABL-negative). B-cell ALL (B-ALL) was diagnosed at median 54 months (range, 5-119) after first exposure to lenalidomide and after median 42 months of cumulative lenalidomide exposure (range, 2-114). High incidence of TP53 mutations (9/19 evaluable cases) and low hypodiploidy (8/26 patients) were identified. Despite median age of 65 years and poor-risk B-ALL features observed in the cohort, rates of complete response (CR) or CR with incomplete hematologic recovery were high (25/28 patients receiving treatment). Median event-free survival was 35.4 months among treated patients (not reached among those undergoing allogeneic hematopoietic cell transplantation [HCT]). Sixteen patients remain alive without evidence of B-ALL after HCT or extended maintenance therapy. We also describe regression of B-ALL or immature B-cell populations with B-ALL immunophenotype after lenalidomide discontinuation in 5 patients, suggesting lenalidomide may drive leukemic progression even after initiation of lymphoblastic neoplasia and that lenalidomide withdrawal alone may be an appropriate first-line intervention in selected patients. Monitoring for early B-ALL-like proliferations may offer opportunities for lenalidomide withdrawal to prevent progression. Established combination chemotherapy regimens, newer surface antigen-targeted approaches, and allogeneic HCT are effective in many patients with lenalidomide-associated B-ALL and should be offered to medically fit patients.
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Affiliation(s)
- Mark B. Geyer
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cell Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian C. Shaffer
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bhavana Bhatnagar
- Section of Hematology/Oncology, Department of Medicine, West Virginia University, West Virginia University Cancer Institute, Morgantown, WV
| | - Alice S. Mims
- Acute Leukemia Program, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Victoria Klein
- Acute Leukemia Program, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Deepika Dilip
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacob L. Glass
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Landau
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yanming Zhang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mikhail Roshal
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cell Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Al-Mashdali AF, Aldapt MB, Rahhal A, Hailan YM, Elhakeem I, Ali EA, Rozi W, Yassin MA. Pediatric Philadelphia-Negative Myeloproliferative Neoplasms in the Era of WHO Classification: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13030377. [PMID: 36766480 PMCID: PMC9914355 DOI: 10.3390/diagnostics13030377] [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: 12/17/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Philadelphia-negative myeloproliferative neoplasms (MPN) are most prevalent in the older population (median age at the diagnosis is above 60 years) and rarely diagnosed in pediatrics. Thus, our knowledge about the clinical presentation, mutational status, and complications of MPNs in pediatrics is limited. METHODS The literature in English (PubMed, SCOPUS, and Google Scholar) was searched for studies, reviews, case series, and case reports of patients with Philadelphia-negative MPNs (including essential thrombocythemia, polycythemia vera, primary myelofibrosis, and profibrotic myelofibrosis) in the pediatrics age group (less than 18 years). Only studies that fulfilled WHO 2008 or 2016 criteria for MPNs were included. We aimed to describe the clinical characteristics, vascular and long-term complications, types of driver mutations, and treatment approaches in pediatric patients with MPNs. RESULTS We reviewed 33 articles of available published literature from 2008 to 2022 and collected data from a total of 196 patients of the pediatric population. Among the cohort of patients, 139 had essential thrombocythemia (ET), 20 had polycythemia vera (PV), and 37 had primary myelofibrosis (PMF). The median age at the time of diagnosis for each disease varied, with 8.8 years for ET, 10 years for PV, and 3.6 years for MF. There was a slight difference in gender prevalence between both gender groups and all three diseases. The presenting symptoms were not mentioned in more than 50% of studies. We found that JAK2 was the most prevalent among all mutations. Both bleeding and thrombosis were present equally in ET, with 9% of cases complicated by bleeding and 9% complicated by thrombosis. Hemorrhagic events did not occur in patients with PV; thrombosis in children with MF was also not found. The progression into AML occurred in two patients with PV and one with ET. CONCLUSION Given the rarity of MPNs in pediatrics and their different characteristics compared with adults, we believe there is a need for unique diagnostic criteria to match the different molecular statuses in pediatrics. Based on our review, the incidence of MPN complications in pediatrics, including thrombotic events, hemorrhage, and leukemic transformation, differs from that in adults.
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Affiliation(s)
- Abdulrahman F. Al-Mashdali
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
- Correspondence: or (A.F.A.-M.); (M.A.Y.)
| | - Mahmood B. Aldapt
- Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, NY 14626, USA
| | - Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Yousef M. Hailan
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Israa Elhakeem
- Clinical Oncology, Hamad Medical Corporation, Doha 3050, Qatar
| | - Elrazi A. Ali
- One Brooklyn Health, Interfaith Medical Center, Internal Medicine Department, Brooklyn, NY 11213, USA
| | - Waail Rozi
- Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Mohamed A. Yassin
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha 3050, Qatar
- Correspondence: or (A.F.A.-M.); (M.A.Y.)
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CD34+ -selected hematopoietic stem cell transplant conditioned with a myeloablative regimen in patients with advanced myelofibrosis. Bone Marrow Transplant 2022; 57:1101-1107. [PMID: 35484207 PMCID: PMC10015419 DOI: 10.1038/s41409-022-01684-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (Allo-HCT) remains the only curative treatment for myelofibrosis (MF). Transplantation in patients with MF is mostly done using a reduced intensity conditioning regimen with calcineurin inhibitors for graft versus host disease (GVHD) prophylaxis. Here we sought to evaluate outcomes of patients who underwent an ex vivo CD34+ -selected allo-HCT using myeloablative conditioning (MAC). Twenty-seven patients were included in this retrospective analysis. All patients were conditioned with busulfan, melphalan and fludarabine and antithymocyte globulin to prevent graft rejection. G-CSF mobilized peripheral blood stem cell grafts were depleted of T-cells using immunomagnetic CD34+ selection by CliniMACS device. Median follow-up among survivors was 50.6 months. The estimated 3-year overall survival, relapse free survival and the combined endpoint of GVHD/relapse free survival were 88% (95% CI, 75-100%), 80% (95% CI, 66-98%) and 74% (95% CI, 59-93%), respectively. The cumulative incidence of grade II-IV acute GVHD at day 100 was 33.3% (95% CI 16.4-51.3%), and two patients suffered chronic GVHD. There were no cases of primary graft failure. However, delayed graft failure occurred in two patients. We conclude that CD34+ selected allo-HCT with a MAC resulted in high survival rates in this cohort of patients with MF.
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Essential Thrombocythemia in Children and Adolescents. Cancers (Basel) 2021; 13:cancers13236147. [PMID: 34885256 PMCID: PMC8656963 DOI: 10.3390/cancers13236147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Among chronic Ph-negative myeloproliferative neoplasms, essential thrombocythemia is found in children with low but increasing incidence. The diagnostic and clinical features do not completely overlap with ET of adult age. A significant number of cases, in fact, do not meet the criteria of clonality, and many cases require extensive clinical evaluation to exclude secondary, reactive forms. Therefore, histological analysis of bone marrow biopsy is necessary, and its use should be enforced. The clinical course appears to be more benign, at least within the first decades of observation, with the incidence of thrombotic events being much lower than in adults (4 % vs. 30%). Hemorrhages are mostly irrelevant. Therefore, the management should be carefully adapted to the individual patient, balancing the risk of future complications with long-term collateral effects of any drug. This review analyzes the peculiarities of the disease facing similarities and differences with adult scenarios. Abstract This paper reviews the features of pediatric essential thrombocythemia (ET). ET is a rare disease in children, challenging pediatric and adult hematologists alike. The current WHO classification acknowledges classical Philadelphia-negative MPNs and defines diagnostic criteria, mainly encompassing adult cases. The presence of one of three driver mutations (JAK2V617F, CALR, and MPL mutations) represent the proof of clonality typical of ET. Pediatric ET cases are thus usually confronted by adult approaches. These can fit only some patients, because only 25–40% of cases present one of the driver mutations. The diagnosis of hereditary, familial thrombocytosis and the exclusion of reactive/secondary thrombocytosis must be part of the diagnostic process in children and can clarify most of the negative cases. Still, many children present a clinical, histological picture of ET, with a molecular triple wild-type status. Moreover, prognosis seems more benign, at least within the first few decades of follow-up. Thrombotic events are rare, and only minor hemorrhages are ordinarily observed. As per the management, the need to control symptoms must be balanced with the collateral effects of lifelong drug therapy. We conclude that these differences concert a compelling case for a very careful therapeutic approach and advocate for the importance of further cooperative studies.
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Yee MEM, Batsuli G, Chonat S, Park S. Thrombocytosis with acquired von Willebrand disease in an adolescent with sickle cell disease. Clin Case Rep 2021; 9:457-460. [PMID: 33489197 PMCID: PMC7813102 DOI: 10.1002/ccr3.3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
Thrombocytosis is common in sickle cell disease and may contribute to vaso-occlusion. Hydroxyurea treats extreme thrombocytosis. Acquired von Willebrand disease should be considered prior to aspirin therapy.
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Affiliation(s)
- Marianne E. M. Yee
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGAUSA
- Department of PediatricsDivision of Hematology/OncologyEmory University School of MedicineAtlantaGAUSA
| | - Glaivy Batsuli
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGAUSA
- Department of PediatricsDivision of Hematology/OncologyEmory University School of MedicineAtlantaGAUSA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGAUSA
- Department of PediatricsDivision of Hematology/OncologyEmory University School of MedicineAtlantaGAUSA
| | - Sunita Park
- Department of Pathology and Laboratory MedicineChildren's Healthcare of AtlantaAtlantaGAUSA
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6
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Comen EA, Bowman RL, Selenica P, Kleppe M, Farnoud NR, Pareja F, Weigelt B, Hill CE, Alon A, Geyer FC, Akturk G, Reis-Filho JS, Norton L, Levine RL. Evaluating Clonal Hematopoiesis in Tumor-Infiltrating Leukocytes in Breast Cancer and Secondary Hematologic Malignancies. J Natl Cancer Inst 2020; 112:107-110. [PMID: 31504684 DOI: 10.1093/jnci/djz157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/10/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy and radiation therapy are the foundations of adjuvant therapy for early-stage breast cancer. As a complication of cytotoxic regimens, breast cancer patients are at risk for therapy-related myeloid neoplasms (t-MNs). These t-MNs are commonly refractory to antileukemic therapies and result in poor patient outcomes. We previously demonstrated that somatic mutations in leukemia-related genes are present in the tumor-infiltrating leukocytes (TILeuks) of a subset of early breast cancers. Here, we performed genomic analysis of microdissected breast cancer tumor cells and TILeuks from seven breast cancer patients who subsequently developed leukemia. In four patients, mutations present in the leukemia were detected in breast cancer TILeuks. This finding suggests that TILeuks in the primary breast cancer may harbor the ancestor of the future leukemogenic clone. Additional research is warranted to ascertain whether infiltrating mutant TILeuks could constitute a biomarker for the development of t-MN and to determine the functional consequences of mutant TILeuks.
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Affiliation(s)
- Elizabeth A Comen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert L Bowman
- Human Oncology and Pathogenesis Program and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pier Selenica
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Kleppe
- Human Oncology and Pathogenesis Program and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Noushin R Farnoud
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Corinne E Hill
- Human Oncology and Pathogenesis Program and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abigail Alon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Felipe C Geyer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Guray Akturk
- Precision Pathology Biobanking Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ross L Levine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Human Oncology and Pathogenesis Program and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY.,Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
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7
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Mughal TI, Deininger MW, Kucine N, Saglio G, Van Etten RA. Children and Adolescents with Chronic Myeloproliferative Neoplasms: Still an Unmet Biological and Clinical Need? Hemasphere 2019; 3:e283. [PMID: 31942538 PMCID: PMC6919464 DOI: 10.1097/hs9.0000000000000283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022] Open
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8
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Safety and efficacy of combined ruxolitinib and decitabine in accelerated and blast-phase myeloproliferative neoplasms. Blood Adv 2019; 2:3572-3580. [PMID: 30563881 DOI: 10.1182/bloodadvances.2018019661] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/08/2018] [Indexed: 11/20/2022] Open
Abstract
Myeloproliferative neoplasms (MPN), including polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have a propensity to evolve into accelerated and blast-phase disease (MPN-AP/BP), carrying a dismal prognosis. Conventional antileukemia therapy has limited efficacy in this setting. Thus, MPN-AP/BP is an urgent unmet clinical need. Modest responses to hypomethylating agents and single-agent ruxolitinib have been reported. More recently, combination of ruxolitinib and decitabine has demonstrated synergistic in vitro activity in human and murine systems. These observations led us to conduct a phase 1 study to explore the safety of combined decitabine and dose-escalated ruxolitinib in patients with MPN-AP/BP. A total of 21 patients were accrued to this multicenter study. Ruxolitinib was administered at doses of 10, 15, 25, or 50 mg twice daily in combination with decitabine (20 mg/m2 per day for 5 days) in 28-day cycles. The maximum tolerated dose was not reached. The most common reasons for study discontinuation were toxicity/adverse events (37%) and disease progression (21%). Fourteen patients died during study treatment period or follow-up. The median overall survival for patients on study was 7.9 months (95% confidence interval, 4.1-not reached). Among evaluable patients, the overall response rate by protocol-defined criteria (complete remission with incomplete count recovery + partial remission) was 9/17 (53%) and by intention-to-treat analysis was 9/21 (42.9%). The combination of decitabine and ruxolitinib was generally well tolerated by patients with MPN-AP/BP and demonstrates potentially promising clinical activity. A phase 2 trial evaluating the efficacy of this combination regimen is ongoing within the Myeloproliferative Disorder Research Consortium.
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9
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Advanced forms of MPNs are accompanied by chromosomal abnormalities that lead to dysregulation of TP53. Blood Adv 2019; 2:3581-3589. [PMID: 30563882 DOI: 10.1182/bloodadvances.2018024018] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 12/22/2022] Open
Abstract
The Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and the prefibrotic form of primary myelofibrosis (PMF), frequently progress to more overt forms of MF and a type of acute leukemia termed MPN-accelerated phase/blast phase (MPN-AP/BP). Recent evidence indicates that dysregulation of the tumor suppressor tumor protein p53 (TP53) commonly occurs in the MPNs. The proteins MDM2 and MDM4 alter the cellular levels of TP53. We investigated in 1,294 patients whether abnormalities involving chromosomes 1 and 12, which harbor the genes for MDM4 and MDM2, respectively, and chromosome 17, where the gene for TP53 is located, are associated with MPN disease progression. Gain of 1q occurred not only in individuals with MPN-BP but also in patients with PV and ET, who, with further follow-up, eventually evolve to either MF and/or MPN-BP. These gains of 1q were most prevalent in patients with a history of PV and those who possessed the JAK2V617F driver mutation. The gains of 1q were accompanied by increased transcript levels of MDM4 In contrast, 12q chromosomal abnormalities were exclusively detected in patients who presented with MF or MPN-BP, but were not accompanied by further increases in MDM2/MDM4 transcript levels. Furthermore, all patients with a loss of 17p13, which leads to a deletion of TP53, had either MF or MPN-AP/BP. These findings suggest that gain of 1q, as well as deletions of 17p, are associated with perturbations of the TP53 pathway, which contribute to MPN disease progression.
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10
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Mughal TI, Pemmaraju N, Radich JP, Deininger MW, Kucine N, Kiladjian JJ, Bose P, Gotlib J, Valent P, Chen CC, Barbui T, Rampal R, Verstovsek S, Koschmieder S, Saglio G, Van Etten RA. Emerging translational science discoveries, clonal approaches, and treatment trends in chronic myeloproliferative neoplasms. Hematol Oncol 2019; 37:240-252. [PMID: 31013548 DOI: 10.1002/hon.2622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 12/19/2022]
Abstract
The 60th American Society of Hematology (ASH) held in San Diego in December 2018 was followed by the 13th Post-ASH chronic myeloproliferative neoplasms (MPNs) workshop on December 4 and 5, 2018. This closed annual workshop, first introduced in 2006 by Goldman and Mughal, was organized in collaboration with Alpine Oncology Foundation and allowed experts in preclinical and clinical research in the chronic MPNs to discuss the current scenario, including relevant presentations at ASH, and address pivotal open questions that impact translational research and clinical management. This review is based on the presentations and deliberations at this workshop, and rather than provide a resume of the proceedings, we have selected some of the important translational science and treatment issues that require clarity. We discuss the experimental and observational evidence to support the intimate interaction between aging, inflammation, and clonal evolution of MPNs, the clinical impact of the unfolding mutational landscape on the emerging targets and treatment of MPNs, new methods to detect clonal heterogeneity, the challenges in managing childhood and adolescent MPN, and reflect on the treatment of systemic mastocytosis (SM) following the licensing of midostaurin.
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Affiliation(s)
- Tariq I Mughal
- Division of Hematology-Oncology, Tufts University Cancer Center, Boston, Massachusetts
| | - Naveen Pemmaraju
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jerald P Radich
- Fred Hutch Cancer Research Center, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Nicole Kucine
- Division of Pediatric Hematology, Weill Cornell Medicine, New York, New York
| | | | - Prithviraj Bose
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute, Stanford, California
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Chih-Cheng Chen
- Chang-Gung Memorial Hospital, Chiayi; College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Tiziano Barbui
- Foundation for Clinical Research (FROM), Papa Giovanni XXIIII Hospital, Bergamo, Italy
| | - Raajit Rampal
- Division of Hematology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Srdan Verstovsek
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steffen Koschmieder
- Department of Medicine IV, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Giuseppe Saglio
- Divison of Hematology, Orbassano University Hospital, Turin, Italy
| | - Richard A Van Etten
- Division of Hematology-Oncology, University of California Irvine, Irvine, California
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11
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Tamari R, Rapaport F, Zhang N, McNamara C, Kuykendall A, Sallman DA, Komrokji R, Arruda A, Najfeld V, Sandy L, Medina J, Litvin R, Famulare CA, Patel MA, Maloy M, Castro-Malaspina H, Giralt SA, Weinberg RS, Mascarenhas JO, Mesa R, Rondelli D, Dueck AC, Levine RL, Gupta V, Hoffman R, Rampal RK. Impact of High-Molecular-Risk Mutations on Transplantation Outcomes in Patients with Myelofibrosis. Biol Blood Marrow Transplant 2019; 25:1142-1151. [PMID: 30625392 DOI: 10.1016/j.bbmt.2019.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
Mutational profiling has demonstrated utility in predicting the likelihood of disease progression in patients with myelofibrosis (MF). However, there is limited data regarding the prognostic utility of genetic profiling in MF patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT). We performed high-throughput sequencing of 585 genes on pre-transplant samples from 101 patients with MF who underwent allo-HCT and evaluated the association of mutations and clinical variables with transplantation outcomes. Overall survival (OS) at 5 years post-transplantation was 52%, and relapse-free survival (RFS) was 51.1 % for this cohort. Nonrelapse mortality (NRM) accounted for most deaths. Patient's age, donor's age, donor type, and Dynamic International Prognostic Scoring System score at diagnosis did not predict for outcomes. Mutations known to be associated with increased risk of disease progression, such as ASXL1, SRSF2, IDH1/2, EZH2, and TP53, did not impact OS or RFS. The presence of U2AF1 (P = .007) or DNMT3A (P = .034) mutations was associated with worse OS. A Mutation-Enhanced International Prognostic Scoring System 70 score was available for 80 patients (79%), and there were no differences in outcomes between patients with high risk scores and those with intermediate and low risk scores. Collectively, these data identify mutational predictors of outcome in MF patients undergoing allo-HCT. These genetic biomarkers in conjunction with clinical variables may have important utility in guiding transplantation decision making.
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Affiliation(s)
- Roni Tamari
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Franck Rapaport
- Center for Clinical and Translational Science, Rockefeller University, New York, New York
| | | | | | | | | | | | - Andrea Arruda
- Princess Margaret Hospital Cancer Center, Toronto, Ontario, Canada
| | | | | | - Juan Medina
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rivka Litvin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Minal A Patel
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly Maloy
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | | | - Damiano Rondelli
- University of Illinois Hospital & Health Sciences System and University of Illinois Cancer Center, Chicago, Illinois
| | | | - Ross L Levine
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vikas Gupta
- Princess Margaret Hospital Cancer Center, Toronto, Ontario, Canada
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12
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Zimran E, Tripodi J, Rampal R, Rappoport F, Zirkiev S, Hoffman R, Najfeld V. Genomic characterization of spleens in patients with myelofibrosis. Haematologica 2018; 103:e446-e449. [PMID: 29748436 DOI: 10.3324/haematol.2018.193763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Eran Zimran
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Joseph Tripodi
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA.,Tumor Cytogenomics Laboratory, Department of Pathology, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Raajit Rampal
- Human Oncology and Pathogenesis Program, Leukemia Service, Memorial Sloan-Kettering Cancer Center, Rockefeller University, New York, NY, USA
| | - Franck Rappoport
- Human Oncology and Pathogenesis Program, Leukemia Service, Memorial Sloan-Kettering Cancer Center, Rockefeller University, New York, NY, USA.,Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Sharon Zirkiev
- Tumor Cytogenomics Laboratory, Department of Pathology, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Ronald Hoffman
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Vesna Najfeld
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA .,Tumor Cytogenomics Laboratory, Department of Pathology, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
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13
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Patterson-Fortin J, Moliterno AR. Molecular Pathogenesis of Myeloproliferative Neoplasms: Influence of Age and Gender. Curr Hematol Malig Rep 2018; 12:424-431. [PMID: 28948454 DOI: 10.1007/s11899-017-0411-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The myeloproliferative neoplasms polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) display distinct clinical and pathologic features but are characterized by mutations in JAK2, MPL, and CALR leading to activation of the JAK-STAT pathway. This review addresses the pathogenesis and mechanisms of these mutant alleles and the unique interactions of both of age and gender.
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Affiliation(s)
- Jeffrey Patterson-Fortin
- Department of Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Nelson-Harvey 808, Baltimore, MD, 21287, USA
| | - Alison R Moliterno
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Building, #1025, Baltimore, MD, 21205, USA.
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14
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Bone marrow histology for the diagnosis of essential thrombocythemia in children: a multicenter Italian study. Blood 2017; 129:3040-3042. [DOI: 10.1182/blood-2017-01-761767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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