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Zhang W, Dun J, Li H, Liu J, Chen H, Yu H, Xu J, Zhou F, Qiu Y, Hao J, Hu Q, Wu X. Analysis 33 patients of non-DS-AMKL with or without acquired trisomy 21 from multiple centers and compared to 118 AML patients. Hematology 2023; 28:2231731. [PMID: 37522469 DOI: 10.1080/16078454.2023.2231731] [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: 12/31/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Acute megakaryoblastic leukemia (AMKL) without Down syndrome (non-DS-AMKL) usually a worse outcome than DS-AMKL. Acquired trisomy 21(+21) was one of the most common cytogenetic abnormalities in non-DS-AMKL. Knowledge of the difference in the clinical characteristics and prognosis between non-DS-AMKL with +21 and those without +21 is limited. OBJECTIVE Verify the clinical characteristics and prognosis of non-DS-AMKL with +21. METHOD We retrospectively analyzed 33 non-DS-AMKL pediatric patients and 118 other types of AML, along with their clinical manifestations, laboratory data, and treatment response. RESULTS Compared with AMKL without +21, AMKL with +21 has a lower platelet count (44.04 ± 5.01G/L) at onset (P > 0.05). Differences in remission rates between AMKL and other types of AML were not significant. Acquired trisomy 8 in AMKL was negatively correlated with the long-term OS rate (P < 0.05), while +21 may not be an impact factor. Compared with the other types of AML, AMKL has a younger onset age (P < 0.05), with a mean of 22.27 months. Anemia, hemorrhage, lymph node enlargement, lower white blood cell, and complex karyotype were more common in AMKL (P < 0.05). AMKL has a longer time interval between onset to diagnosis (53.61 ± 71.15 days) (P < 0.05), and patients with a diagnosis delay ≥3 months always presented as thrombocytopenia or pancytopenia initially. CONCLUSIONS Due to high heterogeneity, high misdiagnosis rate, and myelofibrosis, parts of AMKL may take a long time to be diagnosed, requiring repeated bone marrow punctures. Complex karyotype was common in AMKL. +21 may not be a promising indicator of a poor prognosis.
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Affiliation(s)
- Wenzhi Zhang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jianxin Dun
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Hui Li
- Department of Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jingzhen Liu
- Department of Pediatrics, The Central Hospital of Enshi Autonomous Prefecture, Enshi, People's Republic of China
| | - Hongbo Chen
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Hui Yu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jiawei Xu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Fen Zhou
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yining Qiu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jinjin Hao
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qun Hu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiaoyan Wu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Li F, Xiong Y, Yang M, Chen P, Zhang J, Wang Q, Xu M, Wang Y, He Z, Zhao X, Huang J, Gu X, Zhang L, Sun R, Sun X, Li J, Ou J, Xu T, Huang X, Cao Y, Xu XR, Karakas D, Li J, Ni H, Zhang Q. c-Mpl-del, a c-Mpl alternative splicing isoform, promotes AMKL progression and chemoresistance. Cell Death Dis 2022; 13:869. [PMID: 36229456 PMCID: PMC9561678 DOI: 10.1038/s41419-022-05315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
Acute megakaryocytic leukemia (AMKL) is a clinically heterogeneous subtype of acute myeloid leukemia characterized by unrestricted megakaryoblast proliferation and poor prognosis. Thrombopoietin receptor c-Mpl is a primary regulator of megakaryopoeisis and a potent mitogenic receptor. Aberrant c-Mpl signaling has been implicated in a myriad of myeloid proliferative disorders, some of which can lead to AMKL, however, the role of c-Mpl in AMKL progression remains largely unexplored. Here, we identified increased expression of a c-Mpl alternative splicing isoform, c-Mpl-del, in AMKL patients. We found that c-Mpl-del expression was associated with enhanced AMKL cell proliferation and chemoresistance, and decreased survival in xenografted mice, while c-Mpl-del knockdown attenuated proliferation and restored apoptosis. Interestingly, we observed that c-Mpl-del exhibits preferential utilization of phosphorylated c-Mpl-del C-terminus Y607 and biased activation of PI3K/AKT pathway, which culminated in upregulation of GATA1 and downregulation of DDIT3-related apoptotic responses conducive to AMKL chemoresistance and proliferation. Thus, this study elucidates the critical roles of c-Mpl alternative splicing in AMKL progression and drug resistance, which may have important diagnostic and therapeutic implications for leukemia accelerated by c-Mpl-del overexpression.
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Affiliation(s)
- Fei Li
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Yuanyan Xiong
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Mo Yang
- grid.12981.330000 0001 2360 039XThe Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Peiling Chen
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jingkai Zhang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China ,grid.12981.330000 0001 2360 039XInstitute of Sun Yat-sen University in Shenzhen, Shenzhen, China
| | - Miao Xu
- grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, and Toronto Platelet Immunobiology Group, University of Toronto, Toronto, Canada
| | - Yiming Wang
- grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, and Toronto Platelet Immunobiology Group, University of Toronto, Toronto, Canada ,Canadian Blood Services Centre for Innovation, Toronto, Canada
| | - Zuyong He
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xin Zhao
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Junyu Huang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xiaoqiong Gu
- grid.410737.60000 0000 8653 1072Department of Blood Transfusion, Clinical Biological Resource Bank and Clinical Lab, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Zhang
- grid.410737.60000 0000 8653 1072Department of Blood Transfusion, Clinical Biological Resource Bank and Clinical Lab, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Sun
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xunsha Sun
- grid.12981.330000 0001 2360 039XNational Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyao Li
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jinxin Ou
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Ting Xu
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xueying Huang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Yange Cao
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Ruby Xu
- grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, and Toronto Platelet Immunobiology Group, University of Toronto, Toronto, Canada
| | - Danielle Karakas
- grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, and Toronto Platelet Immunobiology Group, University of Toronto, Toronto, Canada
| | - June Li
- grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, and Toronto Platelet Immunobiology Group, University of Toronto, Toronto, Canada ,Canadian Blood Services Centre for Innovation, Toronto, Canada
| | - Heyu Ni
- grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, and Toronto Platelet Immunobiology Group, University of Toronto, Toronto, Canada ,Canadian Blood Services Centre for Innovation, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physiology, University of Toronto, Toronto, Canada
| | - Qing Zhang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, China ,grid.12981.330000 0001 2360 039XInstitute of Sun Yat-sen University in Shenzhen, Shenzhen, China
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