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Yavaşoğlu İ, Turgutkaya A, Bolaman AZ. Hydroxyurea-Associated Relapsing Polychondritis in a Patient With Myeloproliferative Neoplasm. Ann Pharmacother 2024; 58:557-558. [PMID: 37415323 DOI: 10.1177/10600280231180197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
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Kim HY, Yoo KH, Jung CW, Kim HJ, Kim SH. Genetic Characteristics of Patients with Young-Onset Myelodysplastic Neoplasms. J Clin Med 2023; 12:7651. [PMID: 38137719 PMCID: PMC10743392 DOI: 10.3390/jcm12247651] [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: 09/29/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Myelodysplastic neoplasm (MDS) is a heterogeneous group of myeloid neoplasms affected by germline and somatic genetic alterations. The incidence of MDS increases with age but rarely occurs at a young age. We investigated the germline and somatic genetic alterations of Korean patients with young-onset MDS (<40 years). Among the thirty-one patients, five (16.1%) had causative germline variants predisposing them to myeloid neoplasms (three with GATA2 variants and one each with PGM3 and ETV variants). We found that PGM3 deficiency, a subtype of severe immunodeficiency, predisposes patients to MDS. Somatic mutations were identified in 14 patients (45.2%), with lower rates in patients aged < 20 years (11.1%). Nine (29%) patients had U2AF1 S34F/Y mutations, and patients with U2AF1 mutations showed significantly worse progression-free survival (p < 0.001) and overall survival (p = 0.006) than those without U2AF1 mutations. A UBA1 M41T mutation that causes VEXAS syndrome was identified in a male patient. In conclusion, a germline predisposition to myeloid neoplasms occurred in ~16% of young-onset MDS patients and was largely associated with primary immunodeficiencies, including GATA2 deficiency. Furthermore, the high frequency of somatic U2AF1 mutations in patients with young-onset MDS suggests the presence of a distinct MDS subtype.
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Affiliation(s)
- Hyun-Young Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (H.-Y.K.); (H.-J.K.)
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Chul Won Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (H.-Y.K.); (H.-J.K.)
| | - Sun-Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (H.-Y.K.); (H.-J.K.)
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Fattizzo B, Marchetti A, Zaninoni A, Lionetti M, Riva M, Rizzo L, Pettine L, Galli N, Mazzon F, Fermo E, Maeda A, Marella A, Da Vià MC, Passamonti F, Bolli N, Barcellini W. Immunomodulatory cytokines and clonal dynamics in low-risk myelodysplastic syndromes patients treated with luspatercept. Am J Hematol 2023; 98:E345-E348. [PMID: 37698348 DOI: 10.1002/ajh.27072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alfredo Marchetti
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Anna Zaninoni
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Lionetti
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Riva
- Department of Hematology and Oncology, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | - Lorenzo Rizzo
- Department of Hematology and Oncology, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | - Loredana Pettine
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Galli
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Federico Mazzon
- Department of Hematology and Oncology, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | - Elisa Fermo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Akihiro Maeda
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessio Marella
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Matteo Claudio Da Vià
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Passamonti
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Niccolò Bolli
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Oyogoa E, Streich L, Raess PW, Braun T. Case Report: ASXL1, RUNX1, and IDH1 mutation in tyrosine kinase-independent resistant chronic myeloid leukemia progressing to chronic myelomonocytic leukemia-like accelerated phase. Front Oncol 2023; 13:1217153. [PMID: 37746298 PMCID: PMC10513384 DOI: 10.3389/fonc.2023.1217153] [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: 05/04/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Although the majority of patients with chronic myeloid leukemia (CML) enjoy an excellent prognosis tyrosine kinase inhibitor (TKI) therapy, resistance remains a significant clinical problem. Resistance can arise from mutations in the kinase domain of ABL preventing drug binding, or due to ill-defined kinase-independent mechanisms. In this case report, we describe the case of a 27-year-old woman with a long-standing history of chronic phase (CP) CML who developed kinase-independent resistance with mutations in ASXL1 and RUNX1. As a consequence of uncontrolled disease, she progressed to a chronic myelomonocytic leukemia-like (CMML) accelerated phase (AP) disease with the acquisition of a mutation in IDH1. This disease progression was associated with the development of an inflammatory serositis, a phenomenon that has been described in CMML but not in AP-CML. This case presents key features of kinase-independent resistance with insight into potential mechanisms, highlights management challenges, and describes a novel systemic inflammatory response that occurred in this patient upon disease progression.
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Affiliation(s)
- Emmanuella Oyogoa
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Lukas Streich
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States
| | - Philipp W. Raess
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States
| | - Theodore Braun
- Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, United States
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Fattizzo B, Serpenti F, Versino F, Cassanello G, Cro LM, Barbieri M, Croci GA, Revelli N, Della Porta MG, Barcellini W. Use of steroids in the management of low-risk myelodysplastic syndromes with autoimmune features. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2023; 21:452-460. [PMID: 36580026 PMCID: PMC10497380 DOI: 10.2450/2022.0184-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The boundaries between myelodysplastic syndromes (MDS) and immune-mediated cytopenias are often difficult to establish and both conditions may benefit from immunosuppressive therapy. The optimal timing and doses of immunosuppressants are largely unknown. MATERIALS AND METHODS We systematically evaluated a retrospective cohort of 79 patients with low-risk MDS tested for anti-erythrocyte or anti-platelet autoantibodies to assess their frequency and the efficacy of immunosuppression, particularly with steroids. RESULTS We found autoantibody positivity in 43% of cases and overt autoimmune diseases in 18%, including autoimmune hemolytic anemia, immune thromboctyopenia, and Evans syndrome. Steroid treatment improved cytopenia in about half of patients, with 26% achieving a complete recovery lasting for a median of 12 months. Better responses were observed in anemic patients with anti-erythrocyte autoantibodies than in those with anti-platelet autoantibodies, and the combination with recombinant erythropoietin (7/10) had a possible synergistic effect. Steroid doses were heterogeneous depending on the clinical intent (i.e., anti-inflammatory, immunosuppressive, anabolizing). Patients treated with a dose of 1 mg/kg day of prednisone for overt autoimmune cytopenia showed high rates of complete responses (60%). DISCUSSION This observation suggests a trial with a short course (2-3 weeks) of standard steroid doses to ascertain efficacy and properly silence the autoimmune pathogenic mechanism. Steroid-related adverse events (16% of cases) should be monitored carefully in this elderly, frail population. In conclusion, features of autoimmunity are present in more than two-thirds of low-risk MDS patients and a trial with prednisone 0.5-1 mg/kg day for 2-3 weeks, with proper monitoring of adverse events, may be useful to improve cytopenias in selected cases.
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Affiliation(s)
- Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Fabio Serpenti
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Francesco Versino
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Giulio Cassanello
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Lilla M. Cro
- Cytometry Service, Central Laboratory Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marzia Barbieri
- Cytometry Service, Central Laboratory Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio A. Croci
- Pathology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicoletta Revelli
- Immune-hematology Service, Tranfusion Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Elessa D, Zhao LP, de Oliveira RD, Maslah N, Soret-Dulphy J, Verger E, Marcault C, Parquet N, Fenaux P, Adès L, Raffoux E, Giraudier S, Fain O, Cassinat B, Kiladjian JJ, Mekinian A, Benajiba L. Clinical features and genomic landscape of myeloproliferative neoplasm (MPN) patients with autoimmune and inflammatory diseases (AID). Leukemia 2023; 37:1741-1744. [PMID: 37433887 DOI: 10.1038/s41375-023-01967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Dikelele Elessa
- Sorbonne Université, Service de médecine interne et inflammation, Saint-Antoine Hospital, APHP, Paris, France
| | - Lin-Pierre Zhao
- Université Paris Cité, Clinical Investigations Center, Saint-Louis Hospital, APHP, Paris, France
| | | | - Nabih Maslah
- Université Paris Cité, Cellular biology Department, Saint-Louis Hospital, APHP, Paris, France
- INSERM UMR 1131, Saint-Louis Research Institute, Paris, France
| | - Juliette Soret-Dulphy
- Université Paris Cité, Clinical Investigations Center, Saint-Louis Hospital, APHP, Paris, France
| | - Emmanuelle Verger
- Université Paris Cité, Cellular biology Department, Saint-Louis Hospital, APHP, Paris, France
- INSERM UMR 1131, Saint-Louis Research Institute, Paris, France
| | - Clémence Marcault
- Université Paris Cité, Clinical Investigations Center, Saint-Louis Hospital, APHP, Paris, France
| | - Nathalie Parquet
- Université Paris Cité, Cellular biology Department, Saint-Louis Hospital, APHP, Paris, France
| | - Pierre Fenaux
- Université Paris Cité, Hematology Department, Saint-Louis Hospital, APHP, Paris, France
| | - Lionel Adès
- Université Paris Cité, Hematology Department, Saint-Louis Hospital, APHP, Paris, France
| | - Emmanuel Raffoux
- Université Paris Cité, Hematology Department, Saint-Louis Hospital, APHP, Paris, France
| | - Stéphane Giraudier
- Université Paris Cité, Cellular biology Department, Saint-Louis Hospital, APHP, Paris, France
- INSERM UMR 1131, Saint-Louis Research Institute, Paris, France
| | - Olivier Fain
- Sorbonne Université, Service de médecine interne et inflammation, Saint-Antoine Hospital, APHP, Paris, France
| | - Bruno Cassinat
- Université Paris Cité, Cellular biology Department, Saint-Louis Hospital, APHP, Paris, France
- INSERM UMR 1131, Saint-Louis Research Institute, Paris, France
| | - Jean-Jacques Kiladjian
- Université Paris Cité, Clinical Investigations Center, Saint-Louis Hospital, APHP, Paris, France
- INSERM UMR 1131, Saint-Louis Research Institute, Paris, France
| | - Arsene Mekinian
- Sorbonne Université, Service de médecine interne et inflammation, Saint-Antoine Hospital, APHP, Paris, France.
| | - Lina Benajiba
- Université Paris Cité, Clinical Investigations Center, Saint-Louis Hospital, APHP, Paris, France.
- INSERM UMR 944, Saint-Louis Research Institute, Paris, France.
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Cristiano A, Belardi R, Hajrullaj H, Fabiani E, Falconi G, Galossi E, Bernardini S, Voso MT, Nuccetelli M. Correlation analysis between auto-immunological and mutational profiles in myelodysplastic syndromes. Inflamm Res 2023; 72:1695-1707. [PMID: 37507570 PMCID: PMC10499973 DOI: 10.1007/s00011-023-01773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/12/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE AND DESIGN Systemic-Inflammatory-Autoimmune-Diseases (SIAD) is increasingly considered in Myelodysplastic-Syndromes (MDS). In this line, we evaluated the MDS auto-immunological profile, correlating it to the mutational landscape, trying to identify a molecular-genetic trigger agent related to SIAD. METHODS AND MATERIALS Eighty-one MDS were enrolled and t-NGS was performed. Anti-Nuclear-Antibodies (ANA) were tested, and ANA-antigenic-specificity was characterized by ANA-profile, ENA-screen, anti-dsDNA. Non-Hematological-Patients (NHP) and Healthy-Donors (HD) were used as controls. RESULTS At clinically relevant cut-off (≥ 1:160), ANA was significantly more frequent in MDS, while ANA-antigenic-specificity showed a low association rate. ANA ≥ 1:160-positive MDS showed a mutational landscape similar to ANA-negative/ANA < 1:160 MDS. No significant correlations between mutational and immunological profiles were found and UBA1 mutations, related to VEXAS, were absent. CONCLUSIONS Although ANA-positivity was found to be increased in MDS, the low ANA-antigenic-specificity suggests that autoantibodies didn't recognize autoimmune-pathognomonic antigens. The lack of relationship between genetic profile and ANA-positivity, suggests that MDS genetic variants may not be the direct cause of SIAD.
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Affiliation(s)
- Antonio Cristiano
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| | - Riccardo Belardi
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Hajro Hajrullaj
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Elisa Galossi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
- Tor Vergata University Hospital, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
- Tor Vergata University Hospital, Rome, Italy
| | - Marzia Nuccetelli
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
- Tor Vergata University Hospital, Rome, Italy
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