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Kannan S, Vedia RA, Molldrem JJ. The immunobiology of myelodysplastic neoplasms: a mini-review. Front Immunol 2024; 15:1419807. [PMID: 39355256 PMCID: PMC11443505 DOI: 10.3389/fimmu.2024.1419807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/27/2024] [Indexed: 10/03/2024] Open
Abstract
This mini review summarizes the immunobiology of myelodysplastic syndromes, specifically focusing on the interactions between immune cells, cytokines, and dysplastic cells within the tumor microenvironment in the bone marrow. We elucidate in detail how immune dysregulation and evasion influence the initiation and progression of myelodysplastic syndromes, as well as resistance to therapy and progression to AML. In addition, we highlight a range of therapeutic strategies, including the most recent breakthroughs and experimental therapies for treating MDS. Finally, we address the existing knowledge gaps in the understanding of the immunobiology of MDS and propose future research directions, promising advancements toward enhancing clinical outcomes and survival for patients with MDS.
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Affiliation(s)
- Shruthi Kannan
- Department of Hematopoietic Biology and Malignancy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rolando A Vedia
- Department of Hematopoietic Biology and Malignancy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jeffrey J Molldrem
- Department of Hematopoietic Biology and Malignancy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Evolution of Cancer, Leukemia, and Immunity Post Stem cEll transplant (ECLIPSE), Therapeutics Discovery Division, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, UT MD Anderson Cancer Center, Houston, TX, United States
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Wechalekar MD, Zhao LP, Kutyna MM, Hong LE, Li J, Hung K, Scott HS, Brown A, Hahn CC, Kassahn K, Ladon D, Yeung DT, Thomas D, Patnaik M, Proudman S, Ades L, Shah MV, Kok CH, Hiwase DK. Myeloid neoplasms arising after methotrexate therapy for autoimmune rheumatological diseases do not exhibit poor-risk molecular features. Blood Cancer J 2024; 14:116. [PMID: 39030163 PMCID: PMC11271612 DOI: 10.1038/s41408-024-01093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/21/2024] Open
Affiliation(s)
- Mihir D Wechalekar
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Lin-Pierre Zhao
- Department of Hematology, Hôpital Saint-Louis, Université de Paris, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Université de Paris, Institut de Recherche Saint-Louis, EMiLy, INSERM U1160, Paris, France
- CNRS, GDR3697 "Microenvironment of tumor niches-Micronit", Paris, France
| | - Monika M Kutyna
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lih En Hong
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Joule Li
- Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Kevin Hung
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Hamish S Scott
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Anna Brown
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Christopher C Hahn
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Karin Kassahn
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Dariusz Ladon
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - David T Yeung
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Daniel Thomas
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lionel Ades
- Department of Hematology, Hôpital Saint-Louis, Université de Paris, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Université de Paris, Institut de Recherche Saint-Louis, INSERM U944, Paris, France
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Chung H Kok
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Devendra K Hiwase
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia.
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia.
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3
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Topping J, Taylor A, Nadat F, Crouch S, Ibbotson A, Čermák J, Symeonidis A, Tatic A, Langemeijer S, Hellström-Lindberg E, Culligan D, Garelius HG, Ashcroft J, Nga E, Parker J, Kolade S, McDermott MF, De Witte T, Bowen D, Smith A, Cargo C, Savic S. Inflammatory profile of lower risk myelodysplastic syndromes. Br J Haematol 2024. [PMID: 38772913 DOI: 10.1111/bjh.19530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
The precise link between inflammation and pathogenesis of myelodysplastic syndrome (MDS) is yet to be fully established. We developed a novel method to measure ASC/NLRP3 protein specks which are specific for the NLRP3 inflammasome only. We combined this with cytokine profiling to characterise various inflammatory markers in a large cohort of patients with lower risk MDS in comparison to healthy controls and patients with defined autoinflammatory disorders (AIDs). The ASC/NLRP3 specks were significantly elevated in MDS patients compared to healthy controls (p < 0.001) and these levels were comparable to those found in patients with AIDs. The distribution of protein specks positive only for ASC was different to ASC/NLRP3 ones suggesting that other ASC-containing inflammasome complexes might be important in the pathogenesis of MDS. Patients with MDS-SLD had the lowest levels of interleukin (IL)-1β, tumour necrosis factor (TNF), IL-23, IL-33, interferon (IFN) γ and IFN-α2, compared to other diagnostic categories. We also found that inflammatory cytokine TNF was positively associated with MDS progression to a more aggressive form of disease and IL-6 and IL-1β with time to first red blood cell transfusion. Our study shows that there is value in analysing inflammatory biomarkers in MDS, but their diagnostic and prognostic utility is yet to be fully validated.
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Affiliation(s)
- Joanne Topping
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Adele Taylor
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Fatima Nadat
- Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds, UK
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Alice Ibbotson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Jaroslav Čermák
- Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - Argiris Symeonidis
- Division of Hematology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Saskia Langemeijer
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eva Hellström-Lindberg
- Division of Hematology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dominic Culligan
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - John Ashcroft
- Department of Hematology, Mid Yorkshire Hospitals, Wakefield, UK
| | - Emma Nga
- Department of Haematology, Royal Blackburn Teaching Hospital, Blackburn, Lancashire, UK
| | - Jane Parker
- Northampton General Hospital, Northampton, UK
| | - Seye Kolade
- Department of Haematology, Blackpool Victoria Hospital, Blackpool, Lancashire, UK
| | - Michael F McDermott
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Theo De Witte
- Department of Tumor Immunology, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Bowen
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Catherine Cargo
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Sinisa Savic
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research-Leeds Biomedical Research Centre, Leeds, UK
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Hong LE, Wechalekar MD, Kutyna M, Small A, Lim K, Thompson-Peach C, Li JJ, Chhetri R, Scott HS, Brown A, Hahn CN, Yeung DT, Sajid S, Robinson N, Thomas R, Branford S, D’Andrea RJ, Samaraweera SE, Patnaik M, Proudman S, Thomas D, Kok CH, Shah MV, Hiwase DK. IDH-mutant myeloid neoplasms are associated with seronegative rheumatoid arthritis and innate immune activation. Blood 2024; 143:1873-1877. [PMID: 38457663 PMCID: PMC11076852 DOI: 10.1182/blood.2023023593] [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: 12/18/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024] Open
Abstract
ABSTRACT High prevalence of IDH mutations in seronegative rheumatoid arthritis (RA) with myeloid neoplasm, elevated 2-hydroxyglutarate, dysregulated innate immunity, and proinflammatory microenvironment suggests causative association between IDH mutations and seronegative RA. Our findings merit investigation of IDH inhibitors as therapeutics for seronegative IDH-mutated RA.
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Affiliation(s)
- Lih En Hong
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Mihir D. Wechalekar
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Monika Kutyna
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Annabelle Small
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kelly Lim
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chloe Thompson-Peach
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Joule J. Li
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Rakchha Chhetri
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Hamish S. Scott
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Anna Brown
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Christopher N. Hahn
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - David T. Yeung
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Salvia Sajid
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Nirmal Robinson
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
| | - Ranjeny Thomas
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Susan Branford
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Richard J. D’Andrea
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
| | - Saumya E. Samaraweera
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
| | | | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Daniel Thomas
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chung Hoow Kok
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
| | | | - Devendra K. Hiwase
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Haematology Department, Central Adelaide Local Health Network, Adelaide, Australia
- Blood Cancer, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Jachiet V, Hadjadj J, Zhao LP, Chasset F, Fain O, Fenaux P, Mekinian A. [Dysimmune manifestations associated with myelodysplastic neoplasms and chronic myelomonocytic leukaemias]. Bull Cancer 2023; 110:1147-1155. [PMID: 37414632 DOI: 10.1016/j.bulcan.2023.02.023] [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: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 07/08/2023]
Abstract
Systemic inflammatory or autoimmune diseases (SIAD) are observed in up to a quarter of patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML), with a broad clinical spectrum including asymptomatic biological abnormalities, isolated inflammatory clinical manifestations (recurrent fever, arthralgia, neutrophilic dermatoses…) or identified systemic diseases (giant cell arteritis, recurrent polychondritis…). Recent advances in molecular biology have shed new light on the pathophysiological mechanisms that link inflammatory manifestations and myeloid hemopathies, particularly in VEXAS syndrome following the identification of somatic mutations in the UBA1 gene, or in neutrophilic dermatoses with the concept of myelodysplasia cutis. Although the presence of SIAD does not seem to affect overall survival or the risk of transformation into acute myeloid leukemia, their treatment remains a challenge given the frequent high level of corticosteroid dependence as well as the poor efficacy and tolerance (cytopenias, infections) of conventional immunosuppressive agents. Recent prospective data supports the interest of a therapeutic strategy using demethylating agents and notably azacitidine to target the pathological clone.
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Affiliation(s)
- Vincent Jachiet
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Jérôme Hadjadj
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Lin-Pierre Zhao
- Université de Paris Cité, AP-HP, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France
| | - François Chasset
- Sorbonne université, faculté de médecine, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Tenon, service de dermatologie, Paris, France
| | - Olivier Fain
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Pierre Fenaux
- Université de Paris Cité, AP-HP, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France
| | - Arsène Mekinian
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France.
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Sakuma M, Blombery P, Meggendorfer M, Haferlach C, Lindauer M, Martens UM, Kern W, Haferlach T, Walter W. Novel causative variants of VEXAS in UBA1 detected through whole genome transcriptome sequencing in a large cohort of hematological malignancies. Leukemia 2023; 37:1080-1091. [PMID: 36823397 PMCID: PMC10169658 DOI: 10.1038/s41375-023-01857-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
UBA1 is an X-linked gene and encodes an ubiquitin-activating enzyme. Three somatic mutations altering the alternative start codon (M41) in UBA1 in hematopoietic precursor cells have recently been described, resulting in a syndrome of severe inflammation, cytopenias, and the presence of intracellular vacuoles in hematopoietic precursors - termed VEXAS syndrome, a predominantly male disease. Here we present a patient with clinical features of VEXAS who harbored two novel somatic variants in UBA1 (I894S and N606I). To better understand the clinical relevance and biological consequences of non-M41 (UBA1non-M41) variants, we analyzed the whole genome and transcriptome data of 4168 patients with hematological malignancies and detected an additional 16 UBA1non-M41 putative somatic variants with a clear sex-bias in patients with myeloid malignancies. Patients diagnosed with myeloid malignancies carrying UBA1non-M41 putative somatic variants either had vacuoles or immunodysregulatory symptoms. Analysis of the transcriptome confirmed neutrophil activation in VEXAS patients compared to healthy controls but did not result in a specific transcriptomic signature of UBA1M41 patients in comparison with MDS patients. In summary, we have described multiple putative novel UBA1non-M41 variants in patients with various hematological malignancies expanding the genomic spectrum of VEXAS syndrome.
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Affiliation(s)
- Maki Sakuma
- MLL Munich Leukemia Laboratory, Munich, Germany.,Medical Graduate Center, Technical University Munich, Munich, Germany
| | - Piers Blombery
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Markus Lindauer
- Department for Hematology and Oncology, SLK-Clinics Heilbronn, Heilbronn, Germany
| | - Uwe M Martens
- Department for Hematology and Oncology, SLK-Clinics Heilbronn, Heilbronn, Germany
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Abstract
INTRODUCTION VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described, late-onset, acquired autoinflammatory disorder caused by mutations in the UBA1 gene. The various clinical manifestations of VEXAS broadly divided into inflammatory or haematological. VEXAS defines a new disease category - the hematoinflammatory disorders triggered by somatic mutations restricted to blood but causing systemic inflammation with multi-organ involvement and associated with aberrant bone marrow status. VEXAS causes significant morbidity and reduced life expectancy, but the optimum standard of care remains undefined. AREAS COVERED This review describes the discovery of VEXAS, relevant genetic causes and immunopathology of the disease. A detailed account of its various clinical manifestations and disease mimics is provided. Current treatment and management options are discussed. EXPERT OPINION New rare variants in UBA1 and VEXAS-like UBA1 negative cases are reported. Consensus diagnostic criteria might be required to define VEXAS and its related disorders. Investigation of sporadic, VEXAS-like cases will require the application of deep sequencing using DNA obtained from various cellular or tissue locations. Prospective studies are needed to define the optimal supportive and treatment options for patients with varying disease severity and prognosis. VEXAS-specific hematopoietic stem cell transplant selection criteria also require development.
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Affiliation(s)
- Adam Al-Hakim
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals, NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, School of Medicine, University of Leeds, Leeds, UK
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Takahashi N, Hanajiri R, Suzuki M, Anan C, Inagaki A, Kishida D, Ozawa S, Kohri S, Kamiya N, Sato M, Sato J. <Editors' Choice> Myelodysplastic syndrome with trisomy 8 presenting periodic fever and multiple MEFV gene variants outside exon 10: a case report. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:195-203. [PMID: 36923635 PMCID: PMC10009629 DOI: 10.18999/nagjms.85.1.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/23/2022] [Indexed: 03/18/2023]
Abstract
Myelodysplastic syndrome is associated with the development of autoinflammatory conditions, such as recurrent fever, polymyalgia, arthralgia, and erythema. Trisomy 8 is a common chromosomal abnormality in patients with myelodysplastic syndrome. Myelodysplastic syndrome with trisomy 8 involves autoinflammatory conditions, especially Behçet's disease-like symptoms with intestinal mucosal damage. MEFV variants, particularly those in exon 10, are pathogenic in familial Mediterranean fever, the most common autoinflammatory disease, presenting typical symptoms such as periodic fever and pleuritis/pericarditis/peritonitis. MEFV variants outside exon 10 are common in Japanese patients with familial Mediterranean fever and are associated with atypical symptoms, including myalgia and erythema. MEFV variants in myelodysplastic syndrome with trisomy 8 have rarely been investigated, although myelodysplastic syndrome with trisomy 8 might develop autoinflammatory conditions similar to those in familial Mediterranean fever. We encountered a 67-year-old man who had myelodysplastic syndrome with trisomy 8 and multiple MEFV variants outside exon 10. He presented with periodic fever, as well as chest/abdominal pain, myalgia, and erythema, although the symptoms did not fulfill the diagnostic criteria of familial Mediterranean fever. We discussed the possibility that these symptoms are modified by MEFV variants outside exon 10 in myelodysplastic syndrome with trisomy 8.
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Affiliation(s)
- Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Ryo Hanajiri
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chise Anan
- Department of Neurology, NTT West Tokai Hospital, Nagoya, Japan
| | - Atsushi Inagaki
- Department of Hematology and Oncology, Nagoya City University West Medical Center, Nagoya, Japan.,Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Shohei Ozawa
- Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sho Kohri
- Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Nobuhide Kamiya
- Department of General Medicine, Meitoh Hospital, Nagoya, Japan
| | - Motoki Sato
- Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Juichi Sato
- Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
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9
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Liang Q, Zhao J, Zhang L, Gao Z, Pan H, Fang L, Shi J. Association of systemic inflammatory and autoimmune manifestations with myelodysplastic syndromes: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31427. [PMID: 36401363 PMCID: PMC9678619 DOI: 10.1097/md.0000000000031427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Systemic inflammatory and autoimmune manifestations (SIAMs) are frequently reported in Myelodysplastic syndromes (MDS). Studies focused on the impact of SIMAs on survival outcomes of MDS remains controversial. We performed this systematic review and meta-analysis to determine the association of SIAMs with overall survival, median survival, rate of acute myeloid leukemia transformation and mortality of MDS. MATERIALS AND METHODS An electronic search was conducted in 4 databases without any language restrictions, including PubMed, EMBASE, Medicine and Cochrane library up to April 30, 2021. RESULTS The 18 studies included a total of 4603 MDS patients, of which 1175 (25.5%) patients had SIAMs. MDS patients with SIAMs had a statistically shorter overall survival compared with patient without SIAMs (Hazard ratio, 2.43; 95% confidence interval [CI], 1.34-4.41; P < .01). Our results were most compatible with no effect of SIAMs on median survival, rate of acute myeloid leukemia transformation and mortality (Median survival ratio, 1.16; 95% CI, 0.91-1.47; Odds ratio, 0.96; 95% CI, 0.63-1.45 and 1.2; 95% CI, 0.84-1.7, respectively). CONCLUSION In this systematic review and meta-analysis, SIAMs appeared to have an adverse effect on overall survival of MDS patients. This finding suggested that SIAMs may be a potential independent prognostic factor for MDS.
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Affiliation(s)
- Qian Liang
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Department of Hematology, Zhoukou Central Hospital, Zhoukou, Henan, China
| | - Jingyu Zhao
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Lele Zhang
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhen Gao
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Hong Pan
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Liwei Fang
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jun Shi
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- * Correspondence: Jun Shi, Regenerative Medicine Clinic, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 288 Nanjing Road, Heping District, Tianjin 300020, China (e-mail: )
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10
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Al-Hakim A, Mistry A, Savic S. Improving Diagnosis and Clinical Management of Acquired Systemic Autoinflammatory Diseases. J Inflamm Res 2022; 15:5739-5755. [PMID: 36238769 PMCID: PMC9553278 DOI: 10.2147/jir.s343261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Systemic autoinflammatory diseases (SAID) are conditions caused by dysregulation or disturbance of the innate immune system, with neutrophils and macrophages the main effector cells. Although there are now more than 40 distinct, genetically defined SAIDs, the genetic/molecular diagnosis remains unknown for a significant proportion of patients with the disease onset in adulthood. This review focuses on new developments related to acquired/late onset SAID, including phenocopies of monogenic disorders, Schnitzler's syndrome, Adult onset Still's disease, VEXAS syndrome, and autoinflammatory complications associated with myelodysplastic syndrome.
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Affiliation(s)
- Adam Al-Hakim
- Department of Clinical Immunology and Allergy, St James’s University Hospital, Leeds, UK
| | - Anoop Mistry
- Department of Clinical Immunology and Allergy, St James’s University Hospital, Leeds, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James’s University Hospital, Leeds, UK,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,Correspondence: Sinisa Savic, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Clinical Science Building, St James’s University Hospital, Leeds, LS9 7TF, UK, Tel +441132065567, Email
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11
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Hochman MJ, DeZern AE. Myelodysplastic syndrome and autoimmune disorders: two sides of the same coin? Lancet Haematol 2022; 9:e523-e534. [PMID: 35772431 DOI: 10.1016/s2352-3026(22)00138-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Systemic inflammatory and autoimmune diseases and myelodysplastic syndromes have been linked in individual patients and in larger case series for at least 25 years. These associations frequently include thyroid disease, neutrophilic dermatoses, polyarthritis, connective tissue diseases, vasculitis, and autoimmune cytopenias. Studies have found that autoimmune disease (or its therapy) is a risk factor for the development of myelodysplastic syndromes, but such syndromes might also be an instigator of autoimmune disease. Epidemiological studies examining disease risk in myelodysplastic syndromes with and without comorbid autoimmune illness have reached mixed conclusions. The pathophysiology of myelodysplastic syndromes is tightly linked to excessive inflammatory activity in the bone marrow microenvironment, which could promote systemic inflammatory and autoimmune diseases directly or by stimulation of the adaptive immune response. Alternatively, autoimmune diseases could promote clonal evolution and disordered bone marrow growth, promoting the development of myeloid malignancy. Additionally, therapy-related myeloid neoplasms-including myelodysplastic syndromes-have been diagnosed after treatment of autoimmune diseases with immunosuppressant therapies. These associations raise the following question: are myelodysplastic syndromes and systemic inflammatory and autoimmune diseases two sides of the same coin-that is, do they share an underlying disease state that can manifest as a myeloid neoplasm, an autoinflammatory illness, or both? VEXAS syndrome, which was first reported in 2020, is caused by a mutation that affects myeloid-restricted cells and manifests with both myelodysplasia and autoinflammation, and could give insight into this biological possibility. We note that systemic inflammatory and autoimmune diseases are often steroid-dependent; however, studies have also evaluated the roles of other immunomodulating therapies. In this Viewpoint, we critically appraise and review the literature on the epidemiology, pathophysiology, and management of systemic inflammatory and autoimmune diseases that are associated with myelodysplastic syndromes and related diseases.
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Affiliation(s)
- Michael J Hochman
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy E DeZern
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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12
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Inflammation and myeloid malignancy: Quenching the flame. Blood 2022; 140:1067-1074. [PMID: 35468199 DOI: 10.1182/blood.2021015162] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/22/2022] [Indexed: 01/19/2023] Open
Abstract
Chronic inflammation with aging ("inflammaging") plays a prominent role in the pathogenesis of myeloid malignancies. Aberrant inflammatory activity impacts many different cells in the marrow, including normal blood and stromal marrow elements and leukemic cells, in unique and distinct ways. Inflammation can promote selective clonal expansion through differential immune-mediated suppression of normal hematopoietic cells and malignant clones. We review these complex roles, how they can be understood by separating cell-intrinsic from extrinsic effects, and how this informs future clinical trials.
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13
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Lötscher F, Seitz L, Simeunovic H, Sarbu AC, Porret NA, Feldmeyer L, Borradori L, Bonadies N, Maurer B. Case Report: Genetic Double Strike: VEXAS and TET2-Positive Myelodysplastic Syndrome in a Patient With Long-Standing Refractory Autoinflammatory Disease. Front Immunol 2022; 12:800149. [PMID: 35126364 PMCID: PMC8811255 DOI: 10.3389/fimmu.2021.800149] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Somatic genetic mutations involving the innate and inflammasome signaling are key drivers of the pathogenesis of myelodysplastic syndromes (MDS). Herein, we present a patient, who suffered from a long-standing refractory adult-onset autoinflammatory syndrome (AIS), previously interpreted as various distinct rheumatic disorders. Developing pancytopenia and particularly macrocytic anemia prompted the screening for a hematological malignancy, which led to the diagnosis of a TET-2-positive MDS. The impressive and continuously changing range of organ involvement, with remarkable refractoriness to anti-inflammatory treatment, exceeded the common autoinflammatory phenotype of MDS patients. This prompted us to suspect a recently discovered disease, characterized by somatic mutations of the UBA1 gene: the VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, which was ultimately confirmed by genetic testing. Reevaluation of previous bone marrow biopsies showed the presence of characteristic vacuoles in myeloid- and erythroid progenitor cells. Our case illustrates that the triad of an unresponsive multisystemic autoinflammatory disease, hematological abnormalities and vacuoles in myeloid- and erythroid progenitors in the bone marrow biopsy should prompt screening for the VEXAS syndrome.
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Affiliation(s)
- Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Fabian Lötscher, ; orcid.org/0000-0002-1626-9931
| | - Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helena Simeunovic
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Adela-Cristina Sarbu
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Naomi A. Porret
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Britta Maurer
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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14
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Savic S, Coe J, Laws P. Autoinflammation: Interferonopathies and Other Autoinflammatory Diseases. J Invest Dermatol 2021; 142:781-792. [PMID: 34887082 DOI: 10.1016/j.jid.2021.07.189] [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: 03/17/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022]
Abstract
The family of autoinflammatory diseases (AIDs) continues to expand and now includes over 40 genetically defined disorders. Their defining feature is a dysregulated inflammatory innate immune response. Many AIDs have overlapping clinical characteristics, and dermatological manifestations are common. Autoinflammatory features have also been recognized in more common dermatological conditions such as psoriasis. Furthermore, there is an increasing understanding that immunodeficiencies, autoimmune disorders, and even some allergic disorders share overlapping autoinflammatory features. The discovery that certain somatic mutations, arising within the bone marrow and restricted to the myeloid cell lineage can cause acquired AID heralds a new era of discoveries in this field.
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Affiliation(s)
- Sinisa Savic
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, School of Medicine, University of Leeds, Leeds, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, United Kingdom; Department of Allergy and Clinical Immunology, The Leeds Teaching Hospitals, National Health Service (NHS) Trust, Leeds, United Kingdom.
| | - James Coe
- Leeds Centre for Dermatology, Leeds Teaching Hospitals, National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Philip Laws
- Leeds Centre for Dermatology, Leeds Teaching Hospitals, National Health Service (NHS) Trust, Leeds, United Kingdom
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15
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Camacho V, Kuznetsova V, Welner RS. Inflammatory Cytokines Shape an Altered Immune Response During Myeloid Malignancies. Front Immunol 2021; 12:772408. [PMID: 34804065 PMCID: PMC8595317 DOI: 10.3389/fimmu.2021.772408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022] Open
Abstract
The immune microenvironment is a critical driver and regulator of leukemic progression and hematological disease. Recent investigations have demonstrated that multiple immune components play a central role in regulating hematopoiesis, and dysfunction at the immune cell level significantly contributes to neoplastic disease. Immune cells are acutely sensitive to remodeling by leukemic inflammatory cytokine exposure. Importantly, immune cells are the principal cytokine producers in the hematopoietic system, representing an untapped frontier for clinical interventions. Due to a proinflammatory cytokine environment, dysregulation of immune cell states is a hallmark of hematological disease and neoplasia. Malignant immune adaptations have profound effects on leukemic blast proliferation, disease propagation, and drug-resistance. Conversely, targeting the immune landscape to restore hematopoietic function and limit leukemic expansion may have significant therapeutic value. Despite the fundamental role of the immune microenvironment during the initiation, progression, and treatment response of hematological disease, a detailed examination of how leukemic cytokines alter immune cells to permit, promote, or inhibit leukemia growth is lacking. Here we outline an immune-based model of leukemic transformation and highlight how the profound effect of immune alterations on the trajectory of malignancy. The focus of this review is to summarize current knowledge about the impacts of pro- and anti-inflammatory cytokines on immune cells subsets, their modes of action, and immunotherapeutic approaches with the potential to improve clinical outcomes for patients suffering from hematological myeloid malignancies.
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Affiliation(s)
- Virginia Camacho
- Department of Medicine, Division of Hematology/Oncology, O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, United States
| | - Valeriya Kuznetsova
- Department of Medicine, Division of Hematology/Oncology, O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert S Welner
- Department of Medicine, Division of Hematology/Oncology, O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, United States
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16
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Oganesyan A, Hakobyan Y, Terrier B, Georgin-Lavialle S, Mekinian A. Looking beyond VEXAS: Coexistence of undifferentiated systemic autoinflammatory disease and myelodysplastic syndrome. Semin Hematol 2021; 58:247-253. [PMID: 34802547 DOI: 10.1053/j.seminhematol.2021.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 01/24/2023]
Abstract
It has been established that individuals with myelodysplastic syndromes (MDS) have a higher frequency of systemic inflammatory disorders. On the other hand, patients with autoimmune diseases are at increased risk of MDS development. Both diseases can be associated with various genetic lesions and share diverse pathogenetic mechanisms. Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1, encompasses a range of inflammatory conditions involving multiple organs along with hematological pathologies, including MDS, as well as characteristic bone marrow vacuolization of myeloid and erythroid precursors. This novel syndrome drove further attention to complex associations between MDS and adult-onset inflammatory conditions. The present narrative literature review discusses the clinical presentation, pathophysiology, management of concurrent MDS and systemic inflammatory diseases in parallel to the clinical picture of VEXAS syndrome.
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Affiliation(s)
- Artem Oganesyan
- Department of Adult Hematology, Yeolyan Hematology Center, Yerevan, Armenia; Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Adult Hematology, Yeolyan Hematology Center, Yerevan, Armenia; Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare and Systemic Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Internal Medicine Department, National Reference Center for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Sorbonne Université, INSERM U938, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arsene Mekinian
- Internal Medicine Department and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine (CRSA), Sorbonne Universités, UMPC University Paris 06, INSERM U938, Paris, France.
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17
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Dupuy H, Dussiau C, Bidet A, Sauvezie M, De-Grande AC, Decombe J, Rivière É, Forcade E, Bonnet F, Dumas PY, Duffau P, Pigneux A, Viallard JF, Lazaro E, Dimicoli-Salazar S. Looking for somatic mutations in UBA1 in patients with chronic myelomonocytic leukemia associated with systemic inflammation and autoimmune diseases. Leuk Lymphoma 2021; 63:250-252. [PMID: 34474632 DOI: 10.1080/10428194.2021.1973674] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Henry Dupuy
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Charles Dussiau
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Audrey Bidet
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Mathieu Sauvezie
- Department of Clinical Hematology and Cell Therapy, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Anne-Charlotte De-Grande
- Department of Clinical Hematology and Cell Therapy, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Joël Decombe
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Étienne Rivière
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Edouard Forcade
- Department of Clinical Hematology and Cell Therapy, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Fabrice Bonnet
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Saint André Hospital, Bordeaux, France
| | - Pierre-Yves Dumas
- Department of Clinical Hematology and Cell Therapy, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Pierre Duffau
- Department of Internal Medicine and Clinical Immunology, Bordeaux University Hospital, Saint André Hospital, Bordeaux, France
| | - Arnaud Pigneux
- Department of Clinical Hematology and Cell Therapy, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Jean-François Viallard
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | - Sophie Dimicoli-Salazar
- Department of Clinical Hematology and Cell Therapy, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
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18
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Poulter JA, Collins JC, Cargo C, De Tute RM, Evans P, Ospina Cardona D, Bowen DT, Cunnington JR, Baguley E, Quinn M, Green M, McGonagle D, Beck DB, Werner A, Savic S. Novel somatic mutations in UBA1 as a cause of VEXAS syndrome. Blood 2021; 137:3676-3681. [PMID: 33690815 PMCID: PMC8462400 DOI: 10.1182/blood.2020010286] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- James A Poulter
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Jason C Collins
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Catherine Cargo
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, United Kingdom
| | - Ruth M De Tute
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, United Kingdom
| | - Paul Evans
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, United Kingdom
| | | | - David T Bowen
- Department of Haematology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Joanna R Cunnington
- Department of Rheumatology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Elaine Baguley
- Department of Rheumatology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Mark Quinn
- Department of Rheumatology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom; and
| | - Michael Green
- Department of Rheumatology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom; and
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and
- National Institute for Health Research-Leeds Biomedical Research Centre, University of Leeds, Leeds, United Kingdom
| | - David B Beck
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Achim Werner
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Sinisa Savic
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and
- National Institute for Health Research-Leeds Biomedical Research Centre, University of Leeds, Leeds, United Kingdom
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19
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Abstract
Systemic auto-inflammatory or autoimmune diseases (SIADs) develop in up to a quarter of patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML). With or without the occurrence of SIADs, the distribution of MDS subtypes and the international or CMML-specific prognostic scoring systems have been similar between MDS/CMML patients. Moreover, various SIADs have been described in association with MDS, ranging from limited clinical manifestations to systemic diseases affecting multiple organs. Defined clinical entities including systemic vasculitis, connective tissue diseases, inflammatory arthritis and neutrophilic diseases are frequently reported; however, unclassified or isolated organ impairment can also be seen. Although the presence of SIADs does not impact the overall survival nor disease progression to acute myeloid leukemia, they can help with avoiding steroid dependence and make associated adverse events of immunosuppressive drugs challenging. While therapies using steroids and immunosuppressive treatment remain the backbone of first-line treatment, increasing evidence suggests that MDS specific therapy (hypomethylating agents) and sparing steroids may be effective in treating such complications based on their immunomodulatory effect. The aim of this review was to analyze the epidemiological, pathophysiological, clinical and therapeutic factors of systemic inflammatory and immune disorders associated with MDS.
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