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Alexander C. A History and Current Understanding of Acute Erythroid Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:583-588. [PMID: 37246017 DOI: 10.1016/j.clml.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
Acute erythroid leukemia (AEL) is a highly aggressive subtype of acute myeloid leukemia. Since the first recognition of an erythroid-predominant hematologic malignancy in the early 20th century, AEL has gone through a turnstile of changing definitions and nomenclature, including eritoleucemia, erythremic myelosis, AML-M6 and pure erythroid leukemia. Ever-changing diagnostic criteria and under recognition have stifled our understanding of, and therapeutic options for, this rare erythroid-predominant myeloid neoplasm. It is now well-documented that true AEL, which is characterized primarily by immature erythroid proliferation, often harbors highly complex cytogenetic changes and multiple, deleterious TP53 mutations. These cytogenetic and molecular characteristics render current treatment approaches largely ineffective, and signal an urgent need for novel therapeutic modalities. Due to its rarity and aggressive nature, concerted collaborative efforts must be undertaken in order to improve the outcomes and treatment options for patients with AEL.
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Affiliation(s)
- Coltoff Alexander
- Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC.
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2
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Piqué-Borràs MR, Jevtic Z, Bagger FO, Seguin J, Sivalingam R, Bezerra MF, Louwagie A, Juge S, Nellas I, Ivanek R, Tzankov A, Moll UM, Cantillo O, Schulz-Heddergott R, Fagnan A, Mercher T, Schwaller J. The NFIA-ETO2 fusion blocks erythroid maturation and induces pure erythroid leukemia in cooperation with mutant TP53. Blood 2023; 141:2245-2260. [PMID: 36735909 PMCID: PMC10646783 DOI: 10.1182/blood.2022017273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
The NFIA-ETO2 fusion is the product of a t(1;16)(p31;q24) chromosomal translocation, so far, exclusively found in pediatric patients with pure erythroid leukemia (PEL). To address the role for the pathogenesis of the disease, we facilitated the expression of the NFIA-ETO2 fusion in murine erythroblasts (EBs). We observed that NFIA-ETO2 significantly increased proliferation and impaired erythroid differentiation of murine erythroleukemia cells and of primary fetal liver-derived EBs. However, NFIA-ETO2-expressing EBs acquired neither aberrant in vitro clonogenic activity nor disease-inducing potential upon transplantation into irradiated syngenic mice. In contrast, in the presence of 1 of the most prevalent erythroleukemia-associated mutations, TP53R248Q, expression of NFIA-ETO2 resulted in aberrant clonogenic activity and induced a fully penetrant transplantable PEL-like disease in mice. Molecular studies support that NFIA-ETO2 interferes with erythroid differentiation by preferentially binding and repressing erythroid genes that contain NFI binding sites and/or are decorated by ETO2, resulting in a activity shift from GATA- to ETS-motif-containing target genes. In contrast, TP53R248Q does not affect erythroid differentiation but provides self-renewal and survival potential, mostly via downregulation of known TP53 targets. Collectively, our work indicates that NFIA-ETO2 initiates PEL by suppressing gene expression programs of terminal erythroid differentiation and cooperates with TP53 mutation to induce erythroleukemia.
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Affiliation(s)
- Maria-Riera Piqué-Borràs
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Zivojin Jevtic
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Frederik Otzen Bagger
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Genomic Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Seguin
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Rathick Sivalingam
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Matheus Filgueira Bezerra
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Amber Louwagie
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Sabine Juge
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Ioannis Nellas
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Robert Ivanek
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Ute M. Moll
- Institute of Molecular Oncology, University of Göttingen, Göttingen, Germany
- Department of Pathology, Stony Brook University, Stony Brook, NY
| | - Oriano Cantillo
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | - Alexandre Fagnan
- INSERM U1170, Equipe Labellisée Ligue Contre le Cancer, Gustave Roussy Cancer Center, Université Paris Diderot, Université Paris-Sud, OPALE Carnot Institute, PEDIAC Program, Villejuif, France
| | - Thomas Mercher
- INSERM U1170, Equipe Labellisée Ligue Contre le Cancer, Gustave Roussy Cancer Center, Université Paris Diderot, Université Paris-Sud, OPALE Carnot Institute, PEDIAC Program, Villejuif, France
| | - Juerg Schwaller
- University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
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Cervera N, Guille A, Adélaïde J, Hospital M, Garciaz S, Mozziconacci M, Vey N, Gelsi‐Boyer V, Birnbaum D. Erythroleukemia: Classification. EJHAEM 2023; 4:450-453. [PMID: 37206278 PMCID: PMC10188454 DOI: 10.1002/jha2.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 05/21/2023]
Abstract
Acute erythroid leukemia (AEL) is a rare (2%-5%) form of acute myeloid leukemia (AML). Molecular alterations found in AEL resemble those of other AMLs. We report a classification of AELs in three major classes, with different prognosis and some specific features such as a tendency to mutual exclusion of mutations in epigenetic regulators and signaling genes.
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Affiliation(s)
- Nathalie Cervera
- Laboratoire d'Oncologie PrédictiveCentre de Recherche en Cancérologie de Marseille (CRCM)Institut Paoli‐CalmettesINSERM UMR 1068CNRS UMR725Aix‐Marseille UniversitéMarseilleFrance
| | - Arnaud Guille
- Laboratoire d'Oncologie PrédictiveCentre de Recherche en Cancérologie de Marseille (CRCM)Institut Paoli‐CalmettesINSERM UMR 1068CNRS UMR725Aix‐Marseille UniversitéMarseilleFrance
| | - José Adélaïde
- Laboratoire d'Oncologie PrédictiveCentre de Recherche en Cancérologie de Marseille (CRCM)Institut Paoli‐CalmettesINSERM UMR 1068CNRS UMR725Aix‐Marseille UniversitéMarseilleFrance
| | | | - Sylvain Garciaz
- Département d'HématologieInstitut Paoli‐CalmettesMarseilleFrance
| | | | - Norbert Vey
- Département d'HématologieInstitut Paoli‐CalmettesMarseilleFrance
| | - Véronique Gelsi‐Boyer
- Laboratoire d'Oncologie PrédictiveCentre de Recherche en Cancérologie de Marseille (CRCM)Institut Paoli‐CalmettesINSERM UMR 1068CNRS UMR725Aix‐Marseille UniversitéMarseilleFrance
- Département de BioPathologieInstitut Paoli‐CalmettesMarseilleFrance
| | - Daniel Birnbaum
- Laboratoire d'Oncologie PrédictiveCentre de Recherche en Cancérologie de Marseille (CRCM)Institut Paoli‐CalmettesINSERM UMR 1068CNRS UMR725Aix‐Marseille UniversitéMarseilleFrance
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4
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Maag AH, Swanton H, Kull M, Vegi NM, Feuring M. Immunophenotypical profiling of myeloid neoplasms with erythroid predominance using mass cytometry (CyTOF). Cytometry A 2023. [PMID: 36647792 DOI: 10.1002/cyto.a.24716] [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: 04/12/2022] [Revised: 12/10/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
Acute erythroid leukemia (AEL) is a disease continuum between Myelodysplastic syndrome (MDS) and Acute myeloid leukemia (AML) with the cellular hallmark of uncontrolled proliferation and impaired differentiation of erythroid progenitor cells. First described by Giovanni di Guglielmo in 1917 AEL accounts for less than 5% of all de novo AML cases. There have been efforts to characterize AEL at a molecular level, describing recurrent alterations in TP53, NPM1 and FLT3 genes. A genomic analysis of AEL cases confirmed its complexity. Despite these advances, the biology underlying erythroid proliferations remains unclear and the prognosis is dismal with a median survival of only 3 months for pure erythroid leukemia (PEL). Marker combinations suitable for the identification and characterization of leukemic stem cell (LSC) candidates, monitoring measurable residual disease (MRD) during chemotherapy treatment and the development of innovative targeted therapies are missing. Here, we developed a mass cytometry panel for an in-depth characterization of erythroid and myeloid blast cell populations from human AEL bone marrow samples in comparison to other AML subtypes and healthy counterparts. A total of 8 AEL samples were analyzed and compared to 28 AML samples from different molecular subtypes, healthy bone marrow counterparts (n = 5) and umbilical cord blood (n = 6) using high-dimensional mass cytometry. Identification of erythroid and myeloid blast populations in high-dimensional mass cytometry data enabled a refined view on erythroblast differentiation stages present in AEL erythroid blasts and revealed immunophenotypical profiles specific to AEL. Profiling of phenotypic LSCs revealed aberrant erythroid marker expression in the CD34+ CD38- stem cell compartment. In addition, the identification of novel candidate surface marker combinations and aberrancies might enhance clinical diagnostics of AEL. We present a high-parameter mass cytometry approach feasible for immunophenotypical analysis of blast and stem cell populations in myeloid neoplasms with erythroid predominance laying the foundation for more precise experimental approaches in the future.
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Affiliation(s)
- Abdul-Habib Maag
- Comprehensive Cancer Center, Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
| | - Helen Swanton
- Comprehensive Cancer Center, Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
| | - Miriam Kull
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Naidu M Vegi
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Michaela Feuring
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
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Abstract
Malignancies of the erythroid lineage are rare but aggressive diseases. Notably, the first insights into their biology emerged over half a century ago from avian and murine tumor viruses-induced erythroleukemia models providing the rationale for several transgenic mouse models that unraveled the transforming potential of signaling effectors and transcription factors in the erythroid lineage. More recently, genetic roadmaps have fueled efforts to establish models that are based on the epigenomic lesions observed in patients with erythroid malignancies. These models, together with often unexpected erythroid phenotypes in genetically modified mice, provided further insights into the molecular mechanisms of disease initiation and maintenance. Here, we review how the increasing knowledge of human erythroleukemia genetics combined with those from various mouse models indicate that the pathogenesis of the disease is based on the interplay between signaling mutations, impaired TP53 function, and altered chromatin organization. These alterations lead to aberrant activity of erythroid transcriptional master regulators like GATA1, indicating that erythroleukemia will most likely require combinatorial targeting for efficient therapeutic interventions.
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Adélaïde J, Cervera N, Guille A, Murati A, Chaffanet M, Mozziconacci MJ, Vey N, Birnbaum D, Gelsi-Boyer V. Gains of EPOR and ERG genes in adult erythroleukaemia. Br J Haematol 2020; 189:e174-e177. [PMID: 32227335 DOI: 10.1111/bjh.16586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- José Adélaïde
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France
| | - Nathalie Cervera
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France
| | - Arnaud Guille
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France
| | - Anne Murati
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France.,Département de BioPathologie, Institut Paoli-Calmettes, Marseille, France
| | - Max Chaffanet
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France
| | | | - Norbert Vey
- Hématologie, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Daniel Birnbaum
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France
| | - Véronique Gelsi-Boyer
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille (CRCM), UMR 1068 Inserm, CNRS UMR7258, Institut Paoli-Calmettes, Aix-Marseille Université UM105, Marseille, France.,Département de BioPathologie, Institut Paoli-Calmettes, Marseille, France
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