1
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Li MM, Baranwal A, Gurney M, Shah SN, Al-Kali A, Alkhateeb HB, Foran JM, Arana-Yi C, Ongie L, Chen D, Mangaonkar AA, McCullough K, Tefferi A, Lasho TL, Finke CM, Patnaik MM, Shah MV. The impact of cytotoxic therapy on the risk of progression and death in clonal cytopenia(s) of undetermined significance. Blood Adv 2024:bloodadvances.2023012357. [PMID: 38564774 DOI: 10.1182/bloodadvances.2023012357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/01/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
Clonal cytopenia of undetermined significance (CCUS) is defined by a myeloid driver mutation in the context of otherwise unexplained cytopenia. CCUS has an inherent risk of progressing to myeloid neoplasm. However, it is unknown how exposure to previous cytotoxic therapy may impact the risk of progression and survival. We stratified CCUS patients by prior exposure to DNA-damaging therapy. Of 151 patients, 46 (30%) had received cytotoxic therapy and were classified as therapy-related CCUS (t-CCUS), whereas 105 (70%) had de novo CCUS. A lower proportion of t-CCUS had hypercellular marrows (17.8% vs. 44.8%, P=0.002) but had higher median bone marrow blast percentages. After a median follow up of 2.2 years, t-CCUS had significantly shorter PFS (1.8 vs. 6.3 years, HR 2.1, P=0.007) and median OS (3.6 years vs. not reached, HR 2.3, P=0.007) compared to CCUS. Univariable and multivariable time-to-event analyses showed that exposure to cytotoxic therapy independently accounted for inferior PFS and OS. Despite the similarities in clinical presentation between CCUS and t-CCUS, we show that exposure to prior cytotoxic therapies was an independent risk-factor for inferior outcomes. This suggests that t-CCUS represents a unique clinical entity that needs more stringent monitoring or earlier intervention strategies.
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Affiliation(s)
- Marissa M Li
- Mayo Clinic, Rochester, Minnesota, United States
| | | | - Mark Gurney
- Mayo Clinic, Rochester, Minnesota, United States
| | | | - Aref Al-Kali
- Mayo Clinic, Rochester, Minnesota, United States
| | | | - James M Foran
- Mayo Clinic Florida, Jacksonville, Florida, United States
| | | | - Laura Ongie
- Mayo Clinic, Rochester, Minnesota, United States
| | - Dong Chen
- Mayo Clinic, Rochester, Minnesota, United States
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2
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Johnson IM, Karrar O, Rana M, Iftikhar M, Chen S, McCullough K, Saliba AN, Al-Kali A, Alkhateeb H, Begna K, Litzow M, Hogan WJ, Shah M, Patnaik MM, Pardanani A, Hermann J, Tefferi A, Gangat N. Cardiac events in newly diagnosed acute myeloid leukaemia during treatment with venetoclax + hypomethylating agents. Br J Haematol 2024; 204:1232-1237. [PMID: 38311378 DOI: 10.1111/bjh.19325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Among 301 newly diagnosed patients with acute myeloid leukaemia receiving venetoclax and a hypomethylating agent, 23 (7.6%) experienced major cardiac complications: 15 cardiomyopathy, 5 non-ST elevation myocardial infarction and/or 7 pericarditis/effusions. Four patients had more than one cardiac complication. Baseline characteristics included median age ± interquartile range; 73 ± 5 years; 87% males; 96% with cardiovascular risk factors; and 90% with preserved baseline ejection fraction. In multivariate analysis, males were more likely (p = 0.02) and DNMT3A-mutated cases less likely (p < 0.01) to be affected. Treatment-emergent cardiac events were associated with a trend towards lower composite remission rates (43% vs. 62%; p = 0.09) and shorter survival (median 7.7 vs. 13.2 months; p < 0.01). These observations were retrospectively retrieved and warrant further prospective examination.
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Affiliation(s)
- Isla M Johnson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omer Karrar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Masooma Rana
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunny Chen
- Division of Cardiology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen McCullough
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Antoine N Saliba
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Hermann
- Division of Cardiology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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3
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Baranwal A, Mangaonkar A, Shah MV, Al-Kali A, Tefferi A, Hogan WJ, Litzow MR, Patnaik MM, Alkhateeb HB. EASIX and CPSS Cytogenetics score-based composite risk model for patients with CMML undergoing allogeneic transplant. Bone Marrow Transplant 2024; 59:558-560. [PMID: 38216690 PMCID: PMC10994838 DOI: 10.1038/s41409-023-02184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/12/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Anmol Baranwal
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Cancer Centers of Southwest Oklahoma, Lawton, OK, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mithun V Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William J Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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4
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Tefferi A, Fleti F, Chan O, Al Ali NH, Al-Kali A, Begna KH, Foran JM, Badar T, Khera N, Shah M, Hiwase D, Padron E, Sallman DA, Pardanani A, Arber DA, Orazi A, Reichard KK, He R, Ketterling RP, Gangat N, Komrokji R. TP53 variant allele frequency and therapy-related setting independently predict survival in myelodysplastic syndromes with del(5q). Br J Haematol 2024; 204:1243-1248. [PMID: 38083865 DOI: 10.1111/bjh.19247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 04/11/2024]
Abstract
Among 210 patients with myelodysplastic syndromes (MDSs) with del(5q), molecular information was available at diagnosis or at least 3 months before leukaemic transformation in 146 cases. Multivariate analysis identified therapy-related setting (p = 0.02; HR 2.3) and TP53 variant allele frequency (VAF) ≥22% (p < 0.01; HR 2.8), but not SF3B1 mutation (p = 0.65), as independent risk factors for survival. Median survival was 11.7 versus 4 years (5/10-year survival 73%/52% vs. 42%/14%) in the absence (N = 112) versus presence (N = 34) of ≥1 risk factors; leukaemia-free survival was affected by TP53 VAF ≥22% (p < 0.01). Such information might inform treatment decision-making in MDS-del(5q) regarding allogeneic stem cell transplant.
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Affiliation(s)
- Ayalew Tefferi
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Farah Fleti
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Onyee Chan
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Najla H Al Ali
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Aref Al-Kali
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Kebede H Begna
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - James M Foran
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Talha Badar
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Nandita Khera
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Mithun Shah
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Devendra Hiwase
- Division of Blood Cells and Blood Cancer, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Eric Padron
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - David A Sallman
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Animesh Pardanani
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Kaaren K Reichard
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Rong He
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Rhett P Ketterling
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Naseema Gangat
- Mayo Clinic, Rochester/Jacksonville/Scottsdale, Minnesota/Florida/Arizona, USA
| | - Rami Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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5
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Tefferi A, Pardanani A, Begna KH, Al-Kali A, Hogan WJ, Litzow MR, Ketterling RP, Reichard KK, Gangat N. Calr type 1/like mutation in myelofibrosis is the most prominent predictor of momelotinib drug survival and longevity without transplant. Blood Cancer J 2024; 14:51. [PMID: 38503764 PMCID: PMC10951334 DOI: 10.1038/s41408-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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6
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Farrukh F, Abdelmagid M, Mangaonkar A, Patnaik M, Al-Kali A, Elliott MA, Begna KH, Hook CC, Hogan WJ, Pardanani A, Litzow MR, Ketterling RP, Gangat N, Arber DA, Orazi A, He R, Reichard K, Tefferi A. Prognostic impact of SF3B1 mutation and multilineage dysplasia in myelodysplastic syndromes with ring sideroblasts: a Mayo Clinic study of 170 informative cases. Haematologica 2024. [PMID: 38450522 DOI: 10.3324/haematol.2023.284719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Indexed: 03/08/2024] Open
Abstract
The revised 4th edition of the World Health Organization (WHO4R) classification lists myelodysplastic syndromes with ring sideroblasts (MDS-RS) as a separate entity with single lineage (MDS-RS-SLD) or multilineage (MDS-RS-MLD) dysplasia. The more recent International Consensus Classification (ICC) distinguishes between MDS with SF3B1 mutation (MDS-SF3B1) and MDS-RS without SF3B1 mutation; the latter is instead included under the category of MDS not otherwise specified. The current study includes 170 Mayo Clinic patients with WHO4R-defined MDS-RS, including MDS-RS-SLD (N=83) and MDS-RS-MLD (N=87); a subset of 145 patients were also evaluable for the presence of SF3B1 and other mutations, including 126 with (87%) and 19 (13%) without SF3B1 mutation. Median overall survival for all 170 patients was 6.6 years with 5- and 10-year survival rates of 59% and 25%, respectively. A significant difference in overall survival was apparent between MDS-RS-MLD and MDS-RS-SLD (p<0.01) but not between MDS-RS with and without SF3B1 mutation (p=0.36). Multivariable analysis confirmed the independent prognostic contribution of MLD (HR 1.8, 95% CI 1.1-2.8; p=0.01) and also identified age (p<0.01), transfusion need at diagnosis (p<0.01), and abnormal karyotype (p<0.01), as additional risk factors; the impact from SF3B1 or other mutations was not significant. Leukemia-free survival was independently affected by abnormal karyotype (p<0.01), RUNX1 (0.02) and IDH1 (p=0.01) mutations, but not by MLD or SF3B1 mutation. Exclusion of patients not meeting ICC-criteria for MDSSF3B1 did not change the observations on overall survival. MLD-based, as opposed to SF3B1 mutationbased, disease classification for MDS-RS might be prognostically more relevant.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Rhett P Ketterling
- Divisions of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Rong He
- Divisions of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Kaaren Reichard
- Divisions of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
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7
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Baranwal A, Basmaci R, He R, Viswanatha D, Greipp P, Murthy HS, Foran J, Palmer J, Hogan WJ, Litzow MR, Hefazi M, Mangaonkar A, Shah MV, Al-Kali A, Alkhateeb HB. Genetic features and outcomes of allogeneic transplantation in patients with WT1-mutated myeloid neoplasms. Blood Adv 2024; 8:562-570. [PMID: 38011614 PMCID: PMC10837491 DOI: 10.1182/bloodadvances.2023010960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/05/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
| | - Rami Basmaci
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - David Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Patricia Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
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8
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Gangat N, Karrar O, Iftikhar M, McCullough K, Johnson IM, Abdelmagid M, Abdallah M, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Saliba AN, Hefazi Torghabeh M, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Badar T, Murthy H, Foran J, Palmer J, Sproat L, Khera N, Arana Yi C, Tefferi A. Venetoclax and hypomethylating agent combination therapy in newly diagnosed acute myeloid leukemia: Genotype signatures for response and survival among 301 consecutive patients. Am J Hematol 2024; 99:193-202. [PMID: 38071734 DOI: 10.1002/ajh.27138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 01/21/2024]
Abstract
Venetoclax + hypomethylating agent (Ven-HMA) is currently the standard frontline therapy for older/unfit patients with newly diagnosed acute myeloid leukemia (ND-AML). Our objective in the current retrospective study of 301 adult patients (median age 73 years; 62% de novo) with ND-AML was to identify molecular predictors of treatment response to Ven-HMA and survival; European LeukemiaNet (ELN) genetic risk assignment was favorable 15%, intermediate 16%, and adverse 69%. Complete remission, with (CR) or without (CRi), count recovery, was documented in 182 (60%) patients. In multivariable analysis, inclusive of mutations only, "favorable" predictors of CR/CRi were NPM1 (86% vs. 56%), IDH2 (80% vs. 58%), and DDX41 (100% vs. 58%) and "unfavorable" TP53 (40% vs. 67%), FLT3-ITD (36% vs. 63%), and RUNX1 (44% vs. 64%) mutations; significance was sustained for each mutation after adjustment for age, karyotype, and therapy-related qualification. CR/CRi rates ranged from 36%, in the presence of unfavorable and absence of favorable mutation, to 91%, in the presence of favorable and absence of unfavorable mutation. At median follow-up of 8.5 months, 174 deaths and 41 allogeneic stem cell transplants (ASCT) were recorded. In multivariable analysis, risk factors for inferior survival included failure to achieve CR/CRi (HR 3.4, 95% CI 2.5-4.8), adverse karyotype (1.6, 1.1-2.6), TP53 mutation (1.6, 1.0-2.4), and absence of IDH2 mutation (2.2, 1.0-4.7); these risk factors were subsequently applied to construct an HR-weighted risk model that performed better than the ELN genetic risk model (AIC 1661 vs. 1750): low (n = 130; median survival 28.9 months), intermediate (n = 105; median 9.6 months), and high (n = 66; median 3.1 months; p < .001); survival in each risk category was significantly upgraded by ASCT. The current study identifies genotype signatures for predicting response and proposes a 3-tiered, CR/CRi-based, and genetics-enhanced survival model for AML patients receiving upfront therapy with Ven-HMA.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Isla M Johnson
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Baranwal A, Gurney M, Basmaci R, Katamesh B, He R, Viswanatha DS, Greipp P, Foran J, Badar T, Murthy H, Yi CA, Palmer J, Mangaonkar AA, Patnaik MM, Litzow MR, Hogan WJ, Begna K, Gangat N, Tefferi A, Al-Kali A, Shah MV, Alkhateeb HB. Genetic landscape and clinical outcomes of patients with BCOR mutated myeloid neoplasms. Haematologica 2024. [PMID: 38299584 DOI: 10.3324/haematol.2023.284185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 02/02/2024] Open
Abstract
The BCL6-corepressor (BCOR) is a tumor-suppressor gene located on the short arm of chromosome X. Data is limited regarding factors predicting survival in BCOR-mutated (mBCOR) acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We evaluated 138 patients with mBCOR myeloid disorders, of which 36 (26.1%) had AML and 63 (45.6%) had MDS. Sixty-six (47.8%) patients had a normal karyotype while 18 (13%) patients had complex karyotype. BCOR-mutated MDS/AML were highly associated with RUNX1 and U2AF1 comutations. In contrast, TP53 mutation was infrequently seen with mBCOR MDS. Patients with an isolated BCOR mutation had similar survival compared to those with high-risk co-mutations by ELN 2022 criteria (median OS 1.16 vs. 1.27 years, P = 0.46). Complex karyotype adversely impacted survival among mBCOR AML/MDS (HR 4.12, P < 0.001), while allogeneic stem cell transplant (alloSCT) improved survival (HR 0.38, P = 0.04). However, RUNX1 co-mutation was associated with an increased risk of post-alloSCT relapse (HR 88.0, P = 0.02), whereas melphalan-based conditioning was associated with a decreased relapse-risk (HR 0.02, P = 0.01). We conclude that mBCOR is a high-risk feature across MDS/AML and that alloSCT improves survival in this population.
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Affiliation(s)
- Anmol Baranwal
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Cancer Centers of Southwest Oklahoma, Lawton, OK
| | - Mark Gurney
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rami Basmaci
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Bahga Katamesh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - David S Viswanatha
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Patricia Greipp
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James Foran
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Talha Badar
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Hemant Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Cecilia Arana Yi
- Division of Hematology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - Jeanne Palmer
- Division of Hematology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - William J Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kebede Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mithun V Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
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10
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Xie Z, Lasho T, Khurana A, Ferrer A, Finke C, Mangaonkar AA, Ansell S, Fernandez J, Shah MV, Al-Kali A, Gangat N, Abeykoon J, Witzig TE, Patnaik MM. Prognostic relevance of clonal hematopoiesis in myeloid neoplastic transformation in patients with follicular lymphoma treated with radioimmunotherapy. Haematologica 2024; 109:509-520. [PMID: 37646653 PMCID: PMC10828786 DOI: 10.3324/haematol.2023.283727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
While novel radioisotope therapies continue to advance cancer care, reports of therapy-related myeloid neoplasms (t-MN) have generated concern. The prevalence and role of clonal hematopoiesis (CH) in this process remain to be defined. We hypothesized that: (i) CH is prevalent in relapsed follicular lymphoma and is associated with t-MN transformation, and (ii) radiation in the form of radioimmunotherapy (RIT) plays a role in clonal progression. In this retrospective cohort study, we evaluated the prevalence and prognostic impact of CH on clinical outcomes in 58 heavily pre-treated follicular lymphoma patients who received RIT. Patients had been given a median of four lines of therapy before RIT. The prevalence of CH prior to RIT was 46%, while it was 67% (P=0.15) during the course of RIT and subsequent therapies in the paired samples. Fourteen (24%) patients developed t-MN. Patients with t-MN had a higher variant allele fraction (38% vs. 15%; P=0.02) and clonal complexity (P=0.03) than those without. The spectrum of CH differed from that in age-related CH, with a high prevalence of DNA damage repair and response pathway mutations, absence of spliceosome mutations, and a paucity of signaling mutations. While there were no clear clinical associations between RIT and t-MN, or overall survival, patients with t-MN had a higher mutant clonal burden, along with extensive chromosomal abnormalities (median survival, afer t-MN diagnosis, 0.9 months). The baseline prevalence of CH was high, with an increase in prevalence on exposure to RIT and subsequent therapies. The high rates of t-MN with marked clonal complexities and extensive chromosomal damage underscore the importance of better identifying and studying genotoxic stressors accentuated by therapeutic modalities.
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Affiliation(s)
- Zhuoer Xie
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN, United States; Malignant Hematology Department, H. Lee Moffitt Cancer Center and Research Institute, FL
| | - Terra Lasho
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Arushi Khurana
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Alejandro Ferrer
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Christy Finke
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | | | - Stephen Ansell
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Jenna Fernandez
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Mithun Vinod Shah
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Aref Al-Kali
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Naseema Gangat
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Jithma Abeykoon
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Thomas E Witzig
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN
| | - Mrinal M Patnaik
- Mayo Clinic, Department of Internal Medicine, Hematology Division, Rochester, MN.
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11
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Karrar O, Abdelmagid M, Rana M, Iftikhar M, McCullough K, Al-Kali A, Alkhateeb HB, Begna KH, Elliott MA, Mangaonkar A, Saliba A, Hefazi Torghabeh M, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Badar T, Murthy H, Foran J, Palmer J, Sproat L, Khera N, Arana Yi C, Tefferi A, Gangat N. Venetoclax duration (14 vs. 21 vs. 28 days) in combination with hypomethylating agent in newly diagnosed acute myeloid leukemia: Comparative analysis of response, toxicity, and survival. Am J Hematol 2024; 99:E63-E66. [PMID: 38100217 DOI: 10.1002/ajh.27180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
Overall survival and response rates of 270 patients with newly diagnosed acute myeloid leukemia receiving venetoclax (Ven) plus hypomethylating agent, stratified by Ven dosing schedule (Cycle 1 Ven 14 vs. 21 vs. 28 days).
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Affiliation(s)
- Omer Karrar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maymona Abdelmagid
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Masooma Rana
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen McCullough
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Antoine Saliba
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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12
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Gangat N, Karrar O, Al-Kali A, Begna KH, Elliott MA, Wolanskyj-Spinner AP, Pardanani A, Hanson CA, Ketterling RP, Tefferi A. One thousand patients with essential thrombocythemia: the Mayo Clinic experience. Blood Cancer J 2024; 14:11. [PMID: 38238303 PMCID: PMC10796913 DOI: 10.1038/s41408-023-00972-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024] Open
Abstract
We describe 1000 patients with essential thrombocythemia seen at the Mayo Clinic between 1967 and 2023: median age 58 years (18-90), females 63%, JAK2/CALR/MPL-mutated 62%/27%/3%, triple-negative (TN) 8%, extreme thrombocytosis (ExT; platelets ≥1000 × 109/L) 26%, leukocytosis (leukocyte count >11 × 109/L) 20%, and abnormal karyotype 6%. JAK2-mutated patients were older (median 71 years), and CALR mutated (52 years), and TN (50 years) younger (p < 0.01). Female gender clustered with TN (73%) and JAK2 (69%) vs. CALR/MPL (49%/47%) mutations (p < 0.01). ExT clustered with CALR (type-2 more than type-1) and TN and leukocytosis with JAK2 mutation (p < 0.01). In multivariable analysis, risk factors for overall survival were older age (p < 0.01), male gender (HR 1.8), absolute neutrophil count (ANC) ≥ 8 × 109/L (HR 1.6), absolute lymphocyte count (ALC) < 1.7 × 109/L (HR 1.5), hypertension (HR 1.7), and arterial thrombosis history (HR 1.7); for leukemia-free survival, ExT (HR 2.3) and abnormal karyotype (HR 3.1); for myelofibrosis-free survival, ANC ≥ 8 × 109/L (HR 2.3) and MPL mutation (HR 3.9); for arterial thrombosis-free survival, age ≥60 years (HR 1.9), male gender (HR 1.6), arterial thrombosis history (HR 1.7), hypertension (HR 1.7), and JAK2 mutation (HR 1.8); for venous thrombosis-free survival, male gender (HR 1.8) and venous thrombosis history (HR 3.0). Associations between ExT and leukemic transformation and between ANC and fibrotic progression were limited to JAK2-mutated cases. Aspirin therapy appeared to mitigate both arterial (HR 0.4) and venous (HR 0.4) thrombosis risk. HR-based risk models delineated patients with median survivals ranging from 10 years to not reached and 20-year leukemia/myelofibrosis incidences from 3%/21% to 12.8%/49%. The current study provides both novel and confirmatory observations of essential thrombocythemia.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Curtis A Hanson
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P Ketterling
- Division of Laboratory Medicine and Cytogenetics, Mayo Clinic, Rochester, MN, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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13
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Garcia-Manero G, McCloskey J, Griffiths EA, Yee KWL, Zeidan AM, Al-Kali A, Deeg HJ, Patel PA, Sabloff M, Keating MM, Zhu N, Gabrail NY, Fazal S, Maly J, Odenike O, Kantarjian H, DeZern AE, O'Connell CL, Roboz GJ, Busque L, Buckstein R, Amin H, Randhawa J, Leber B, Shastri A, Dao KH, Oganesian A, Hao Y, Keer HN, Azab M, Savona MR. Oral decitabine-cedazuridine versus intravenous decitabine for myelodysplastic syndromes and chronic myelomonocytic leukaemia (ASCERTAIN): a registrational, randomised, crossover, pharmacokinetics, phase 3 study. Lancet Haematol 2024; 11:e15-e26. [PMID: 38135371 DOI: 10.1016/s2352-3026(23)00338-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The DNA methyltransferase inhibitors azacitidine and decitabine for individuals with myelodysplastic syndromes or chronic myelomonocytic leukaemia are available in parenteral form. Oral therapy with similar exposure for these diseases would offer potential treatment benefits. We aimed to compare the safety and pharmacokinetics of oral decitabine plus the cytidine deaminase inhibitor cedazuridine versus intravenous decitabine. METHODS We did a registrational, multicentre, open-label, crossover, phase 3 trial of individuals with myelodysplastic syndromes or chronic myelomonocytic leukaemia and individuals with acute myeloid leukaemia, enrolled as separate cohorts; results for only participants with myelodysplastic syndromes or chronic myelomonocytic leukaemia are reported here. In 37 academic and community-based clinics in Canada and the USA, we enrolled individuals aged 18 years or older who were candidates to receive intravenous decitabine, with Eastern Cooperative Oncology Group performance status 0 or 1 and a life expectancy of at least 3 months. Participants were randomly assigned (1:1) to receive 5 days of oral decitabine-cedazuridine (one tablet once daily containing 35 mg decitabine and 100 mg cedazuridine as a fixed-dose combination) or intravenous decitabine (20 mg/m2 per day by continuous 1-h intravenous infusion) in a 28-day treatment cycle, followed by 5 days of the other formulation in the next treatment cycle. Thereafter, all participants received oral decitabine-cedazuridine from the third cycle on until treatment discontinuation. The primary endpoint was total decitabine exposure over 5 days with oral decitabine-cedazuridine versus intravenous decitabine for cycles 1 and 2, measured as area under the curve in participants who received the full treatment dose in cycles 1 and 2 and had decitabine daily AUC0-24 for both oral decitabine-cedazuridine and intravenous decitabine (ie, paired cycles). On completion of the study, all patients were rolled over to a maintenance study. This study is registered with ClinicalTrials.gov, NCT03306264. FINDINGS Between Feb 8, 2018, and June 7, 2021, 173 individuals were screened, 138 (80%) participants were randomly assigned to a treatment sequence, and 133 (96%) participants (87 [65%] men and 46 [35%] women; 121 [91%] White, four [3%] Black or African-American, three [2%] Asian, and five [4%] not reported) received treatment. Median follow-up was 966 days (IQR 917-1050). Primary endpoint of total exposure of oral decitabine-cedazuridine versus intravenous decitabine was 98·93% (90% CI 92·66-105·60), indicating equivalent pharmacokinetic exposure on the basis of area under the curve. The safety profiles of oral decitabine-cedazuridine and intravenous decitabine were similar. The most frequent adverse events of grade 3 or worse were thrombocytopenia (81 [61%] of 133 participants), neutropenia (76 [57%] participants), and anaemia (67 [50%] participants). The incidence of serious adverse events in cycles 1-2 was 31% (40 of 130 participants) with oral decitabine-cedazuridine and 18% (24 of 132 participants) with intravenous decitabine. There were five treatment-related deaths; two deemed related to oral therapy (sepsis and pneumonia) and three to intravenous treatment (septic shock [n=2] and pneumonia [n=1]). INTERPRETATION Oral decitabine-cedazuridine was pharmacologically and pharmacodynamically equivalent to intravenous decitabine. The results support use of oral decitabine-cedazuridine as a safe and effective alternative to intravenous decitabine for treatment of individuals with myelodysplastic syndromes or chronic myelomonocytic leukaemia. FUNDING Astex Pharmaceuticals.
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Affiliation(s)
| | - James McCloskey
- John Thuerer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Karen W L Yee
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Amer M Zeidan
- Yale Cancer Center, Yale University, New Haven, CT, USA
| | | | | | - Prapti A Patel
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mitchell Sabloff
- University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Nancy Zhu
- University of Alberta, Edmonton, AB, Canada
| | | | - Salman Fazal
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Joseph Maly
- Norton Cancer Institute, Louisville, KY, USA
| | | | - Hagop Kantarjian
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | | | - Gail J Roboz
- New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | | | - Rena Buckstein
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Harshad Amin
- Boca Raton Clinical Research, Boca Raton, FL, USA
| | | | - Brian Leber
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | | | | | - Yong Hao
- Astex Pharmaceuticals, Pleasanton, CA, USA
| | | | | | - Michael R Savona
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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14
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Tefferi A, Pardanani A, Al-Kali A, Alkhateeb H, McCullough K, Patnaik M, Hogan WJ, Begna K, Elliott MA, Khera N, Palmer JM, Gangat N, Kelemen K, Orazi A, Chen D, Reichard KK. Mast cell cytomorphology and treatment outcome in mast cell leukemia. Am J Hematol 2024; 99:E5-E8. [PMID: 37732882 DOI: 10.1002/ajh.27105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M Palmer
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katalin Kelemen
- Division of Hematopathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Attilio Orazi
- Division of Hematopathology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Pardanani A, Tefferi A, Al-Kali A, Patnaik M, Hogan WJ, Begna K, Elliott MA, Khera N, Palmer JM, Gangat N, Orazi A, Kelemen K, Reichard KK, Chen D. Reappraisal of mast cell leukemia based on a single institution review of 16 cases: Mast cell morphology determines clinical outcome. Am J Hematol 2024; 99:E1-E4. [PMID: 37688525 DOI: 10.1002/ajh.27089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Cytologic abnormalities of atypical mast cells in mastocytosis. The mature mast cells have oval-shaped nuclei, cytoplasmic hypogranulation and spindle-shaped cytology. or well-differentiated displaying a round nucleus with condensed chromatin, and abundant dense cytoplasmic granulations. Immature mast cells include promastocytes and metachromatic blast-like forms.
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Affiliation(s)
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M Palmer
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Katalin Kelemen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Tefferi A, Abdelmagid M, Al-Kali A, Patnaik M, Hogan WJ, Begna K, Gangat N, Orazi A, Chen D, Reichard KK, Pardanani A. Granularity in disease classification impacts survival prediction in advanced systemic mastocytosis: A single institution study of 329 informative cases. Am J Hematol 2024; 99:21-27. [PMID: 37772442 DOI: 10.1002/ajh.27113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
The World Health Organization (WHO) classification system categorizes advanced systemic mastocytosis (SM-Adv) into aggressive SM (ASM), mast cell leukemia (MCL), and SM with associated hematological neoplasm (SM-AHN). By contrast, the International Consensus Classification (ICC) requires "immature" MC cytomorphology for the diagnosis of MCL and limits SM-AHN to myeloid neoplasms (SM-AMN). The current study includes 329 patients with SM-Adv (median age 65 years, range 18-88; males 58%): WHO subcategories SM-AHN (N = 212; 64%), ASM (N = 99; 30%), and MCL (N = 18; 6%); ICC subcategories SM-AMN (N = 190; 64%), ASM (N = 99; 33%), and MCL (N = 9; 3%); WHO-defined MCL with "mature" MC cytomorphology and SM-AHN associated with lymphoid neoplasms were operationally labeled as "MCL-mature" (N = 9) and SM-ALN (N = 22), respectively, and distinguished from ICC-defined MCL and SM-AMN. Multivariable analysis that included the Mayo alliance risk factors for survival in SM (age >60 years, anemia, thrombocytopenia, increased alkaline phosphatase) revealed more accurate survival prediction with the ICC versus WHO classification order: (i) survival was significantly worse with MCL-immature versus MCL-mature (hazard ratio [HR] 15; p < .01), (ii) prognostic distinction between MCL and SM-AHN/AMN was confirmed in the context of ICC (HR 9.3; p < .01) but not WHO classification order (p = .99), (iii) survival was similar between MCL-mature and SM-AMN (p = .18), and (iv) SM-AMN (HR 1.7; p < .01) but not SM-ALN (p = .37) was prognostically distinct from ASM. The current study provides evidence for the independent prognostic contribution of both the ICC system for SM-Adv and the Mayo alliance risk factors for survival in SM.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maymona Abdelmagid
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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17
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Nanaa A, He R, Foran JM, Badar T, Gangat N, Pardanani A, Hogan WJ, Litzow MR, Patnaik M, Al-Kali A, Alkhateeb HB. Venetoclax plus hypomethylating agents in DDX41-mutated acute myeloid leukaemia and myelodysplastic syndrome: Mayo Clinic series on 12 patients. Br J Haematol 2024; 204:171-176. [PMID: 37710381 DOI: 10.1111/bjh.19105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
Venetoclax (VEN) is an FDA-approved selective inhibitor of B-cell leukaemia/lymphoma-2 (BCL-2), used for treating elderly or unfit acute myeloid leukaemia (AML) patients unable to undergo intensive chemotherapy. Combining VEN with hypomethylating agents (HMAs) has shown impressive response rates in high-risk myelodysplastic syndromes (MDS) and relapsed/refractory AML. However, the efficacy of VEN and HMAs in treating DDX41-mutated (mDDX41) MDS/AML patients remains uncertain. Despite the favourable prognostic nature of mDDX41 MDS/AML patients, there is a lack of clinical experience regarding their response to different treatment regimens, leading to an unknown optimal therapeutic approach.
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Affiliation(s)
- Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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18
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Gangat N, McCullough K, Abdelmagid M, Karrar O, Powell M, Al-Kali A, Alkhateeb H, Begna K, Mangaonkar A, Saliba A, Torghabeh MH, Litzow M, Hogan W, Shah M, Patnaik M, Pardanani A, Badar T, Foran J, Palmer J, Sproat L, Yi CA, Tefferi A. Molecular predictors of response and survival following IDH1/2 inhibitor monotherapy in acute myeloid leukemia. Haematologica 2024; 109:187-292. [PMID: 37534525 PMCID: PMC10772527 DOI: 10.3324/haematol.2023.283732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | | | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, AZ
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19
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Badar T, Nanaa A, Foran JM, Viswanatha D, Al-Kali A, Lasho T, Finke C, Alkhateeb HB, He R, Gangat N, Shah M, Tefferi A, Mangaonkar AA, Litzow MR, Ongie LJ, Chlon T, Ferrer A, Patnaik MM. Clinical and molecular correlates of somatic and germline DDX41 variants in patients and families with myeloid neoplasms. Haematologica 2023; 108:3033-3043. [PMID: 37199125 PMCID: PMC10620593 DOI: 10.3324/haematol.2023.282867] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
The diagnosis of germline predisposition to myeloid neoplasms (MN) secondary to DDX41 variants is currently hindered by the long latency period, variable family histories and the frequent occurrence of DDX41 variants of uncertain significance (VUS). We reviewed 4,524 consecutive patients who underwent targeted sequencing for suspected or known MN and analyzed the clinical impact and relevance of DDX41VUS in comparison to DDX41path variants. Among 107 patients (44 [0.9%] DDX41path and 63 DDX41VUS [1.4%; 11 patients with both DDX41path and DDX41VUS]), we identified 17 unique DDX41path and 45 DDX41VUS variants: 24 (23%) and 77 (72%) patients had proven and presumed germline DDX41 variants, respectively. The median age was similar between DDX41path and DDX41VUS (66 vs. 62 years; P=0.41). The median variant allele frequency (VAF) (47% vs. 48%; P=0.62), frequency of somatic myeloid co-mutations (34% vs 25%; P= 0.28), cytogenetic abnormalities (16% vs. 12%; P=>0.99) and family history of hematological malignancies (20% vs. 33%; P=0.59) were comparable between the two groups. Time to treatment in months (1.53 vs. 0.3; P=0.16) and proportion of patients progressing to acute myeloid leukemia (14% vs. 11%; P=0.68), were similar. The median overall survival in patients with high-risk myelodysplastic syndrome/acute myloid leukemia was 63.4 and 55.7 months in the context of DDX41path and DDX41VUS, respectively (P=0.93). Comparable molecular profiles and clinical outcomes among DDX41path and DDX41VUS patients highlights the need for a comprehensive DDX41 variant interrogation/classification system, to improve surveillance and management strategies in patients and families with germline DDX41 predisposition syndromes.
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Affiliation(s)
- Talha Badar
- Division of Hematology-Oncology and Bone Marrow Transplant Program, Mayo Clinic, Jacksonville, FL 32224.
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA; John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612
| | - James M Foran
- Division of Hematology-Oncology and Bone Marrow Transplant Program, Mayo Clinic, Jacksonville, FL 32224
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | - Terra Lasho
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | - Christy Finke
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | | | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN 55905
| | | | - Timothy Chlon
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, 45229
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20
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Gurney M, Greipp PT, Gliem T, Knudson R, Al-Kali A, Gangat N, Lasho T, Mangaonkar AA, Finke CM, Patnaik MM. TET2 somatic copy number alterations and allelic imbalances in chronic myelomonocytic leukemia. Leuk Res 2023; 134:107391. [PMID: 37769597 DOI: 10.1016/j.leukres.2023.107391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Mark Gurney
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA; Cytogenetics Core Facility, Mayo Clinic, Rochester, MN, USA
| | - Troy Gliem
- Cytogenetics Core Facility, Mayo Clinic, Rochester, MN, USA
| | - Ryan Knudson
- Cytogenetics Core Facility, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Terra Lasho
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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21
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Gangat N, Ilyas R, Johnson IM, McCullough K, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Tefferi A. Outcome of patients with acute myeloid leukemia following failure of frontline venetoclax plus hypomethylating agent therapy. Haematologica 2023; 108:3170-3174. [PMID: 36861409 PMCID: PMC10620560 DOI: 10.3324/haematol.2022.282677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
| | - Rimal Ilyas
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
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22
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Badar T, Vanegas YAM, Nanaa A, Foran JM, Al-Kali A, Mangaonkar A, Murthy H, Alkhateeb HB, Viswanatha D, He R, Shah M, Yi CA, Litzow MR, Gangat N, Tefferi A, Patnaik MM. U2AF1 pathogenic variants in myeloid neoplasms and precursor states: distribution of co-mutations and prognostic heterogeneity. Blood Cancer J 2023; 13:149. [PMID: 37735430 PMCID: PMC10514309 DOI: 10.1038/s41408-023-00922-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
We have previously recognized the genotypic and prognostic heterogeneity of U2AF1 mutations (MT) in myelofibrosis (MF) and myelodysplastic syndromes (MDS). In the current study, we considered 179 U2AF1-mutated patients with clonal cytopenia of undetermined significance (CCUS; n = 22), MDS (n = 108), MDS/acute myeloid leukemia (AML; n = 18) and AML (n = 31). U2AF1 variants included S34 (60%), Q157 (35%), and others (5%): corresponding mutational frequencies were 45%, 55%, and 0% in CCUS; 57%, 39%, and 4% in MDS; 61%, 33%, and 6% in MDS/AML; and 55%, 35% and 10% in AML (P = 0.17, 0.36 and 0.09), respectively. Concurrent mutations included ASXL1 (37%), BCOR (19%), RUNX1 (14%), TET2 (15%), DNMT3A (10%), NRAS/KRAS (8%), TP53 (8%), JAK2 (5.5%) and SETBP1 (5%). The two most frequent U2AF1 MT were S34F (n = 97) and Q157P (n = 46); concurrent MT were more likely to be seen with the latter (91% vs 74%; P = 0.01) and abnormal karyotype with the former (70% vs 62%; P = 0.05). U2AF1 S34F MT clustered with BCOR (P = 0.04) and Q157P MT with ASXL1 (P = 0.01) and TP53 (P = 0.03). The median overall survival (OS) in months was significantly worse in AML (14.2) vs MDS/AML (27.3) vs MDS (33.7; P = 0.001); the latter had similar OS with CCUS (30.0). In morphologically high-risk disease (n = 49), defined by ≥10% blood or bone marrow blasts (i.e., AML or MDS/AML), median OS was 14.2 with Q157P vs 37.1 months in the presence of S34F (P = 0.008); transplant-adjusted multivariable analysis confirmed the detrimental impact of Q157P (P = 0.01) on survival and also identified JAK2 MT as an additional risk factor (P = 0.02). OS was favorably affected by allogeneic hematopoietic stem cell transplantation (HR: 0.16, 95% CI; 0.04-0.61, P = 0.007). The current study defines the prevalence and co-mutational profiles of U2AF1 pathogenic variants in AML, MDS/AML, MDS, and CCUS, and suggests prognostic heterogeneity in patients with ≥10% blasts.
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Affiliation(s)
- Talha Badar
- Division of Hematology-Oncology and Bone Marrow Transplant Program, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Yenny A Moreno Vanegas
- Division of Hematology-Oncology and Bone Marrow Transplant Program, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, 60612, USA
| | - James M Foran
- Division of Hematology-Oncology and Bone Marrow Transplant Program, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Hemant Murthy
- Division of Hematology-Oncology and Bone Marrow Transplant Program, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - David Viswanatha
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Cecilia Arana Yi
- Department of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
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23
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Abdelmagid MG, Al-Kali A, Begna KH, Hogan WJ, Litzow MR, Fleti F, Mangaonkar AA, Patnaik MS, Elliott MA, Alkhateeb H, Shi M, Howard MT, Reichard KK, Ketterling RP, Shah M, Pardanani A, Gangat N, Tefferi A. Blast phase myeloproliferative neoplasm with prior exposure to ruxolitinib: comparative analysis of mutations and survival. Haematologica 2023; 108:2542-2545. [PMID: 36794509 PMCID: PMC10483339 DOI: 10.3324/haematol.2022.282627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Min Shi
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Matthew T Howard
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Kaaren K Reichard
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
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24
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Abdelmagid MG, Al-Kali A, Litzow MR, Begna KH, Hogan WJ, Patnaik MS, Hashmi SK, Elliott MA, Alkhateeb H, Karrar OS, Fleti F, Elnayir MH, Rivera CE, Murthy HS, Foran JM, Kharfan-Dabaja MA, Badar T, Viswanatha DS, Reichard KK, Gangat N, Tefferi A. Real-world experience with ponatinib therapy in chronic phase chronic myeloid leukemia: impact of depth of response on survival and prior exposure to nilotinib on arterial occlusive events. Blood Cancer J 2023; 13:122. [PMID: 37567878 PMCID: PMC10421909 DOI: 10.1038/s41408-023-00891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
We surveyed the performance of ponatinib, as salvage therapy, in a real-world setting of chronic phase chronic myeloid leukemia (CML-CP). Among 55 consecutive patients (median age 49 years) with relapsed/refractory CML-CP, 35 (64%) had failed ≥3 tyrosine kinase inhibitors (TKIs), 35 (64%) were pre-treated with nilotinib, and 14 (28%) harbored ABL1T315I. At start of ponatinib (median dose 30 mg/day), 40 patients were already in complete hematologic (CHR), 4 in complete cytogenetic (CCyR), 3 in major molecular (MMR) remission, while 8 had not achieved CHR (NR). Ponatinib improved the depth of response in 13 (33%), 3 (75%), 2 (66%), and 4 (50%) patients with CHR, CCyR, MMR, and NR, respectively (p = 0.02). At a median follow-up of 42 months, 13 (23%) deaths, 5 (9%) blast transformations, and 25 (45%) allogeneic transplants were recorded. Five/10-year post-ponatinib survival was 77%/58% with no significant difference when patients were stratified by allogeneic transplant (p = 0.94), ponatinib-induced deeper response (p = 0.28), or a post-ponatinib ≥CCyR vs CHR remission state (p = 0.25). ABL1T315I was detrimental to survival (p = 0.04) but did not appear to affect response. Prior exposure to nilotinib was associated with higher risk of arterial occlusive events (AOEs; 11% vs 0%; age-adjusted p = 0.04). Ponatinib starting/maintenance dose (45 vs 15 mg/day) did not influence either treatment response or AOEs. Our observations support the use of a lower starting/maintenance dose for ponatinib in relapsed/refractory CML-CP but a survival advantage for deeper responses was not apparent and treatment might not overcome the detrimental impact of ABL1T315I on survival. The association between prior exposure to nilotinib and a higher risk of post-ponatinib AOEs requires further validation.
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Affiliation(s)
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | - Omer S Karrar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Farah Fleti
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | - David S Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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25
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Gurney M, Mangaonkar AA, Lasho T, Finke C, Al-Kali A, Gangat N, Shah MV, Alkhateeb HB, Tefferi A, Sallman D, Xie Z, Viswanatha D, Reichard K, Al Ali N, Komrokji R, Padron E, Patnaik MM. Somatic TP53 single nucleotide variants, indels and copy number alterations in chronic myelomonocytic leukemia (CMML). Leukemia 2023; 37:1753-1756. [PMID: 37422593 DOI: 10.1038/s41375-023-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Mark Gurney
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Terra Lasho
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Christy Finke
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Sallman
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Zhuoer Xie
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - David Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kaaren Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Najla Al Ali
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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26
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Gangat N, Kuykendall A, Al Ali N, Goel S, Abdelmagid M, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Komrokji R, Tefferi A. Black African-American patients with primary myelofibrosis: a comparative analysis of phenotype and survival. Blood Adv 2023; 7:2694-2698. [PMID: 36780345 PMCID: PMC10333736 DOI: 10.1182/bloodadvances.2022009611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 02/14/2023] Open
Affiliation(s)
| | - Andrew Kuykendall
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Najla Al Ali
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Swati Goel
- Department of Oncology (Hematology), Montefiore Medical Center, Bronx, NY
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
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27
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Gurney M, Chekkaf I, Baranwal A, Basmaci R, Katamesh B, Greipp P, Foran JM, Badar T, Mangaonkar AA, Begna KH, Gangat N, Patnaik MM, Litzow MR, Shah MV, Viswanatha DS, He R, Alkhateeb HB, Al-Kali A. The clinical and molecular spectrum of ETV6 mutated myeloid neoplasms. Br J Haematol 2023. [PMID: 37144345 DOI: 10.1111/bjh.18850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
ETV6 mutations are rare but recurrent somatic events in myeloid neoplasms and are negatively prognostic in myelodysplastic syndrome. We set out to examine the clinical and molecular characteristics of patients undergoing investigation for myeloid neoplasms, found to have deleterious ETV6 mutations. ETV6 mutations occurred in 33 of 5793 (0.6%) cases investigated and predominantly in high-risk disease entities including MDS with increased blasts, primary myelofibrosis and AML, myelodysplasia-related. In three cases, isolated iso (17q) karyotype was concurrently detected, an otherwise rare karyotype in myeloid neoplasms. ETV6 mutations were frequently subclonal and never occurred as an isolated abnormality with ASXL1 (n = 22, 75%), SRSF2 (n = 14, 42%) and SETBP1 (n = 11, 33%) the predominant co-mutations. Restricting to patients with MDS, higher rates of ASXL1, SETBP1, RUNX1 and U2AF1 mutations occurred in ETV6 mutated cases, relative to a consecutive control cohort with wild-type ETV6. The median OS of the cohort was 17.5 months. This report highlights the clinical and molecular associations of somatic ETV6 mutations in myeloid neoplasms, suggests their occurrence as a later event, and proposes further translational research questions for their role in myeloid neoplasia.
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Affiliation(s)
- Mark Gurney
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anmol Baranwal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rami Basmaci
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bahga Katamesh
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia Greipp
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - James M Foran
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rong He
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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28
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Gangat N, Abdallah M, Szuber N, Saliba A, Alkhateeb H, Al-Kali A, Begna KH, Pardanani A, Tefferi A. Sodium-glucose co-transporter-2 inhibitor use and JAK2 unmutated erythrocytosis in 100 consecutive cases. Am J Hematol 2023. [PMID: 37073574 DOI: 10.1002/ajh.26933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mostafa Abdallah
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Natasha Szuber
- Department of Hematology, Université de Montréal, Montréal, Quebec, Canada
| | - Antoine Saliba
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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29
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Tibes R, Kosiorek HE, Dueck AC, Palmer J, Sproat L, Bogenberger J, Hashmi S, Mesa R, Hogan W, Litzow MR, Al-Kali A. Phase 1/1b study of azacitidine and hedgehog pathway inhibitor sonidegib in patients with myeloid neoplasms. Cancer 2023. [PMID: 37042080 DOI: 10.1002/cncr.34800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Myeloid neoplasms (myelodysplastic syndrome [MDS], myelofibrosis, and chronic myelomonocytic [CMML]) are aggressive hematological malignancies for which, despite recent approvals, novel therapies are needed to improve clinical outcomes. The hedgehog (HH) pathway is one of the main pathways for cancer stem cells survival and several HH inhibitors (HHi) are approved in clinical practice. METHODS Sonidegib (SON), an oral HHi, was tested in this phase 1/1b trial in combination with azacitidine (AZA, 75 mg/m2 days ×7) in patients with newly diagnosed and relapsed/refractory (r/r) chronic MN or acute myeloid leukemia (AML). RESULTS Sixty-two patients (28 [45%] newly diagnosed) were treated in this study, including 10 patients in the dose-finding component and 52 patients in phase 1b. SON 200 mg oral daily on days 1-28 each cycle was deemed the recommended dose for phase 1b. Out of 21 rrAML patients, two achieved response (one complete response/one morphologic leukemia-free state) with no responses seen in seven r/r MDS/CMML patients. In newly diagnosed AML/MDS, response was seen in six (three had complete remission, two had morphological leukemia-free status) of 27 patients. Median overall survival was 26.4 and 4.7 months for newly diagnosed MDS and AML, respectively. Safety was satisfactory with common (>20%) side effects including fatigue, constipation, nausea, cough, insomnia, and diarrhea. Only 7% of patients died in the study, and none of the deaths were deemed related to treatment. CONCLUSIONS Our study shows that AZA + SON are a safe combination in a patient with MN. Similar to other hedgehog inhibitors, this combination yielded limited response rate in patients with myeloid neoplasms.
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Affiliation(s)
- Raoul Tibes
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
- AstraZeneca, Cambridge, UK
| | - Heidi E Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Amylou C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne Palmer
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - James Bogenberger
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shahrukh Hashmi
- Department of Hematology and Oncology, Sheikh Shakhbout Medical Center, Abu Dhabi, United Arab Emirates
| | - Ruben Mesa
- Department of Hematology and Medical Oncology, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - William Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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30
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Shah MV, Tran ENH, Shah S, Chhetri R, Baranwal A, Ladon D, Shultz C, Al-Kali A, Brown AL, Chen D, Scott HS, Greipp P, Thomas D, Alkhateeb HB, Singhal D, Gangat N, Kumar S, Patnaik MM, Hahn CN, Kok CH, Tefferi A, Hiwase DK. TP53 mutation variant allele frequency of ≥10% is associated with poor prognosis in therapy-related myeloid neoplasms. Blood Cancer J 2023; 13:51. [PMID: 37041128 PMCID: PMC10090194 DOI: 10.1038/s41408-023-00821-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/13/2023] Open
Abstract
Revised diagnostic criteria for myeloid neoplasms (MN) issued by the International Consensus Classification (ICC) and the World Health Organization (WHO) recommended major change pertaining to TP53-mutated (TP53mut) MN. However, these assertions have not been specifically examined in therapy-related myeloid neoplasm (t-MN), a subset enriched with TP53mut. We analyzed 488 t-MN patients for TP53mut. At least one TP53mut with variant allele frequency (VAF) ≥ 2% with or without loss of TP53 locus was noted in 182 (37.3%) patients and 88.2% of TP53mut t-MN had a VAF ≥10%. TP53mut t-MN with VAF ≥ 10% had a distinct clinical and biological profile compared to both TP53mut VAF < 10% and wild-type TP53 (TP53wt) cases. Notably, TP53mut VAF ≥ 10% had a significantly shorter survival compared to TP53wt (8.3 vs. 21.6 months; P < 0.001), while the survival of TP53mut VAF < 10% was comparable to TP53wt. Within TP53mut VAF ≥ 10% cohort, the inferior outcomes persisted irrespective of the single- or multi-hit status, co-mutation pattern, or treatments received. Finally, survival of TP53mut patients was poor across all the blast categories and MDS patients with >10% blasts had inferior survival compared to <5%. In summary, TP53mut VAF ≥10% signified a clinically and molecularly homogenous cohort regardless of the allelic status.
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Affiliation(s)
| | - Elizabeth Ngoc Hoa Tran
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Syed Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rakchha Chhetri
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | | | - Dariusz Ladon
- Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Carl Shultz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Anna L Brown
- University of Adelaide, Adelaide, SA, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Dong Chen
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hamish S Scott
- University of Adelaide, Adelaide, SA, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Patricia Greipp
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Thomas
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | | | - Deepak Singhal
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | | | - Sharad Kumar
- University of Adelaide, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | | | - Christopher N Hahn
- University of Adelaide, Adelaide, SA, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Chung Hoow Kok
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | | | - Devendra K Hiwase
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
- University of Adelaide, Adelaide, SA, Australia.
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia.
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31
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Al-Kali A, Nanaa A, Viswanatha D, He R, Nguyen P, Jevremovic D, Foran JM, Yi CA, Greipp PT, Gangat N, Patnaik M, Tefferi A, Litzow MR, Mangaonkar AA, Shah MV, Badar T, Alkhateeb HB. Observation and treatment in DDX41-mutated acute myeloid leukemia and myelodysplastic syndrome. Blood Cancer J 2023; 13:49. [PMID: 37032414 PMCID: PMC10083167 DOI: 10.1038/s41408-023-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, 60612, USA
| | - David Viswanatha
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Phuong Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | | | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL, 32224, USA
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32
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Fleti F, Chan O, Singh A, Abdelmagid MG, Al-Kali A, Elliott MA, Begna KH, Foran JM, Badar T, Khera N, Al Ali NH, Padron E, Sallman DA, Shah M, Hiwase D, Pardanani A, Arber DA, Orazi A, Reichard KK, He R, Ketterling RP, Gangat N, Komrokji R, Tefferi A. TP53 mutations and variant allele frequency in myelodysplastic syndromes with del(5q): A Mayo-Moffitt study of 156 informative cases. Am J Hematol 2023; 98:E76-E79. [PMID: 36655582 DOI: 10.1002/ajh.26845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Affiliation(s)
- Farah Fleti
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Onyee Chan
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Amritpal Singh
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Maymona G Abdelmagid
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Aref Al-Kali
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Michelle A Elliott
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Kebede H Begna
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - James M Foran
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Talha Badar
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Najla H Al Ali
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Eric Padron
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - David A Sallman
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Mithun Shah
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Devendra Hiwase
- Division of Blood Cells and Blood Cancer, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Animesh Pardanani
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Kaaren K Reichard
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Rong He
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Rhett P Ketterling
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Naseema Gangat
- Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic, Jacksonville, Florida, USA
- Mayo Clinic, Scottsdale, Arizona, USA
| | - Rami Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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33
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Abdallah M, McCullough K, Ilyas R, Begna KH, Al-Kali A, Litzow MR, Hogan WJ, Mangaonkar A, Alkhateeb H, Shah MV, Elliott MA, Foran JM, Badar T, Palmer JM, Yi CA, Sproat L, Pardanani A, Patnaik MM, Olteanu H, Ketterling RP, Tefferi A, Gangat N. Abnormal karyotype is an independent predictor of inferior survival in Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN). Blood Cancer J 2023; 13:35. [PMID: 36907917 PMCID: PMC10008821 DOI: 10.1038/s41408-023-00812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023] Open
Affiliation(s)
| | | | - Rimal Ilyas
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P Ketterling
- Division of Laboratory Medicine and Cytogenetics, Mayo Clinic, Rochester, MN, USA
| | | | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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34
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Gipe N, Leung N, Lasho T, Mangaonkar A, Alkhateeb H, Al-Kali A, Gangat N, Hogan W, McCullough K, Tefferi A, Alexander MP, Patnaik MM. Spectrum of renal pathological findings in patients with chronic myelomonocytic leukemia and kidney injury. Am J Hematol 2023; 98:E148-E153. [PMID: 36880366 DOI: 10.1002/ajh.26902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Nate Gipe
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Terra Lasho
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen McCullough
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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35
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Hiwase D, Hahn C, Tran ENH, Chhetri R, Baranwal A, Al-Kali A, Sharplin K, Ladon D, Hollins R, Greipp P, Kutyna M, Alkhateeb H, Badar T, Wang P, Ross DM, Singhal D, Shanmuganathan N, Bardy P, Beligaswatte A, Yeung D, Litzow MR, Mangaonkar A, Giri P, Lee C, Yong A, Horvath N, Singhal N, Gowda R, Hogan W, Gangat N, Patnaik M, Begna K, Tiong IS, Wei A, Kumar S, Brown A, Scott H, Thomas D, Kok CH, Tefferi A, Shah MV. TP53 mutation in therapy-related myeloid neoplasm defines a distinct molecular subtype. Blood 2023; 141:1087-1091. [PMID: 36574363 DOI: 10.1182/blood.2022018236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Devendra Hiwase
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Christopher Hahn
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Elizabeth Ngoc Hoa Tran
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Rakchha Chhetri
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Kirsty Sharplin
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Dariusz Ladon
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Rachel Hollins
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Patricia Greipp
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Monika Kutyna
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | | | - Talha Badar
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Paul Wang
- ACRF Cancer Genomic Facility, SA Pathology, Adelaide, SA, Australia
| | - David M Ross
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Deepak Singhal
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Naranie Shanmuganathan
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Peter Bardy
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Ashanka Beligaswatte
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Yeung
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | | | | | - Pratyush Giri
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Cindy Lee
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Angie Yong
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Noemi Horvath
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nimit Singhal
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Raghu Gowda
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | | | | | | | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ing S Tiong
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Andrew Wei
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Sharad Kumar
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Anna Brown
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Hamish Scott
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
- Genetic and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Daniel Thomas
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Chung H Kok
- Precision Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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36
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Al-Kali A, Tibes R, Atherton P, Palmer J, Alkhateeb HB, Patnaik M, Begna K, Gangat N, Hashmi S, He R, Litzow M. A phase II study of combination daunorubicin, cytarabine (Ara-c), and nilotinib (TAsigna) (DATA) in patients newly diagnosed with acute myeloid leukemia with KIT expression. Am J Hematol 2023; 98:472-480. [PMID: 36625066 DOI: 10.1002/ajh.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
Acute myeloid leukemia (AML) is a challenging cancer in terms of achieving and maintaining long-duration remissions. Many novel therapies have been added to the standard regimen (combining cytarabine and anthracycline "7 + 3") to achieve such goals. Nilotinib is an oral multikinase inhibitor that is active against KIT tyrosine kinase, an important stem cell target. In this trial, we combined nilotinib with 7 + 3 induction (daunorubicin 60 mg/m2), high-dose cytarabine consolidation, and subsequently, if the patient was a candidate, for 2 years' maintenance therapy in patients with AML and KIT (CD117) expression. Patients were allowed to proceed to allogeneic hematopoietic cell transplantation (HCT) if deemed necessary. Our primary goal was increased complete remission rate with this combination. Thirty-four patients (with a median age 58.5 years) were enrolled on a single-arm phase II bi-institutional study; 21 (62%) patients achieved remission. The complete remission rate was 78% in evaluable patients. Thirteen of 34 (38%) patients had allogeneic HCT, all thirteen of which are still alive (100%). Common (>20%) grade 3 non-hematological toxicities included febrile neutropenia, hypophosphatemia, elevated liver enzymes, and hypertension. Only one patient (3%) died in induction due to liver failure, which was thought secondary to daunorubicin. Our current study reveals good outcomes in patients who received HCT and may warrant a larger study to confirm our findings in that specific population.
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Affiliation(s)
- Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raoul Tibes
- AstraZeneca, Cambridge, UK.,Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Pamela Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanne Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahrukh Hashmi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rong He
- Division of hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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37
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Katamesh B, Nanaa A, He R, Viswanatha DS, Nguyen P, Greipp PT, Foran J, Badar T, Litzow MR, Hogan WJ, Mangaonkar A, Shah MV, Al-Kali A, Alkhateeb HB. Hematopoietic Stem Cell Transplant Outcome in STAG2-Mutated Myeloid Neoplasms. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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38
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Baranwal A, Mangaonkar A, Shah MV, Al-Kali A, Tefferi A, Hogan WJ, Litzow MR, Patnaik MM, Alkhateeb HB. Cpss Cytogenetics and Easix Score Based Composite Survival Model for Patients with CMML Undergoing Allogeneic Transplant. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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39
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Gangat N, Begna KH, Al-Kali A, Hogan W, Litzow M, Pardanani A, Tefferi A. Predictors of anemia response to momelotinib therapy in myelofibrosis and impact on survival. Am J Hematol 2023; 98:282-289. [PMID: 36349465 DOI: 10.1002/ajh.26778] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
We retrospectively reviewed 72 anemic patients with myelofibrosis (MF; median age 68 years), who were JAK2 inhibitor-naïve at the time of study entry to a phase-1/2 momelotinib clinical trial. Driver mutation profile included JAK2 69%, CALR 17%, MPL 8%, and triple-negative 6%; other mutations included ASXL1 39% and SRSF2 17%. Momelotinib was administered at a median dose of 300 mg daily. Anemia response was assessed by formal criteria and documented in 44% of all patients with hemoglobin levels below the sex-adjusted reference range (n = 72), 48% of those with hemoglobin <10 g/dl (n = 54), and 46% of those who were transfusion-dependent at the time of study entry (n = 28). Anemia response was more likely with post-essential thrombocythemia MF (83% vs 37%; p = .001), lower serum ferritin (p = .003), and shorter time from diagnosis to momelotinib therapy (p = .001); the first two variables were also predictive in transfusion-dependent patients. Post-momelotinib median survival was 3.2 years; in univariate analysis, survival was superior in anemia responders (median 3.8 vs. 2.8 years; p = .14) and in the presence of type 1/like CALR mutation and inferior in the presence of age > 65 years, ASXL1/SRSF2 mutation, unfavorable karyotype, DIPSS-plus high risk, red cell transfusion need and higher serum ferritin. Multivariable analysis confirmed the favorable impact of anemia response on survival (p = .02; HR 0.5, 3/5/10-year survival; 69%/38%/25%). This survival advantage was also noted in transfusion-dependent patients (3.7 vs. 1.9 years; p = .01; HR 0.3) and appeared to be restricted to patients with an unfavorable genetic profile. The current study suggests a short-term survival benefit associated with anemia response in momelotinib-treated patients with MF.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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40
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Pritzl SL, Gurney M, Badar T, Ferrer A, Lasho T, Finke C, Mangaonkar A, McCullough K, Gangat N, Fernandez J, Al-Kali A, Viswanatha D, He R, Foran J, Patnaik MM. Clinical and molecular spectrum and prognostic outcomes of U2AF1 mutant clonal hematopoiesis- a prospective mayo clinic cohort study. Leuk Res 2023; 125:107007. [PMID: 36586169 DOI: 10.1016/j.leukres.2022.107007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/18/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Stephanie L Pritzl
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Mark Gurney
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Talha Badar
- Mayo Clinic, Division of Hematology and Oncology, Jacksonville, FL, USA
| | - Alejandro Ferrer
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Terra Lasho
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Christy Finke
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Abhishek Mangaonkar
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Kristen McCullough
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Naseema Gangat
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Jenna Fernandez
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - Aref Al-Kali
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA
| | - David Viswanatha
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Rong He
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - James Foran
- Mayo Clinic, Division of Hematology and Oncology, Jacksonville, FL, USA
| | - Mrinal M Patnaik
- Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN, USA.
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41
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Gangat N, Ilyas R, McCullough K, Begna KH, Al-Kali A, Patnaik MM, Litzow MR, Hogan WJ, Mangaonkar A, Alkhateeb H, Shah MV, Elliott MA, Foran JM, Badar T, Palmer JM, Hanson CA, Pardanani A, Tefferi A. Predictors of response to venetoclax plus hypomethylating agent therapy and survival in blast-phase myeloproliferative neoplasm. Haematologica 2022; 108:1423-1428. [PMID: 36519330 PMCID: PMC10153526 DOI: 10.3324/haematol.2022.282019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 12/23/2022] Open
Abstract
Not available.
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Affiliation(s)
| | - Rimal Ilyas
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville FL
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville FL
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42
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Gangat N, Chetram D, McCullough K, Al-Kali A, Begna K, Hogan W, Litzow M, Foran J, Badar T, Palmer J, Patnaik M, Pardanani A, Tefferi A. Limited activity of luspatercept in myelofibrosis and myeloid neoplasms other than myelodysplastic syndromes with ring sideroblasts. Am J Hematol 2022; 97:E474-E477. [PMID: 36197043 DOI: 10.1002/ajh.26749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Deandra Chetram
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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43
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Tefferi A, Pardanani A, Begna KH, Al-Kali A, Hogan WJ, Litzow MR, Hanson CA, Ketterling RP, Gangat N. Momelotinib for myelofibrosis: 12-year survival data and retrospective comparison to ruxolitinib. Am J Hematol 2022; 97:E433-E435. [PMID: 36057774 DOI: 10.1002/ajh.26714] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis A Hanson
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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44
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Katamesh B, Nanaa A, He R, Viswanatha D, Nguyen P, Greipp P, Foran J, Begna K, Gangat N, Patnaik M, Tefferi A, Litzow M, Mangaonkar A, Shah MV, Badar T, Alkhateeb HB, Al-Kali A. Autoimmune manifestations in STAG2-mutated myeloid neoplasms. Ann Hematol 2022; 101:2785-2787. [PMID: 36184685 DOI: 10.1007/s00277-022-04995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Bahga Katamesh
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, 60612, USA
| | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - David Viswanatha
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Phuong Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Patricia Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mithun Vinod Shah
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Hassan B Alkhateeb
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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45
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Singh A, Al-Kali A, Foran JM, Elliott MA, Begna K, Badar T, Khera N, Fleti F, Abdelmagid M, Reichard KK, Ketterling RP, Pardanani A, Gangat N, Tefferi A. Lenalidomide therapy for primary myelodysplastic syndromes with isolated del(5q): Determinants of response and survival in a real-world setting. Am J Hematol 2022; 97:E377-E379. [PMID: 35959963 DOI: 10.1002/ajh.26672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Amritpal Singh
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - James M Foran
- Jacksonville, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle A Elliott
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Badar
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Farah Fleti
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Maymona Abdelmagid
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Kareen K Reichard
- Division of Hematopathology, Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Rhett P Ketterling
- Division of Hematopathology, Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Divisions of Hematology Rochester, Mayo Clinic, Rochester, Minnesota, USA
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46
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Tefferi A, Singh A, Gangat N, Al-Kali A, Alkhateeb H, Shah M, Patnaik MS, Elliott MA, Hogan WJ, Litzow MR, Wolanskyj-Spinner A, Hook CC, Mangaonkar A, Viswanatha D, Chen D, Pardanani A, Begna KH, Ketterling RP. Adverse karyotype subcategories in acute myeloid leukemia display significant differences in mutation composition and transplant-augmented survival. Haematologica 2022; 108:245-249. [PMID: 36073516 PMCID: PMC9827171 DOI: 10.3324/haematol.2022.281495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - David Viswanatha
- Division of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dong Chen
- Division of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rhett P. Ketterling
- Division of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA,R. P. KETTERLING -
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47
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Nanaa A, He R, Viswanatha D, Nguyen P, Jevremovic D, Foran JM, Yi CA, Greipp PT, Gangat N, Patnaik M, Tefferi A, Litzow MR, Mangaonkar AA, Shah MV, Badar T, Alkhateeb HB, Al-Kali A. Comparison between GATA2 and DDX41-mutated myeloid neoplasms. Leuk Res 2022; 121:106931. [PMID: 36037623 DOI: 10.1016/j.leukres.2022.106931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA; John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA
| | - David Viswanatha
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Phuong Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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48
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Baranwal A, Nanaa A, Viswanatha D, He R, Foran J, Badar T, Hogan WJ, Litzow MR, Shah MV, Patnaik MM, Al-Kali A, Alkhateeb HB. Outcomes of allogeneic transplant in patients with DDX41 mutated myelodysplastic syndrome and acute myeloid leukemia. Bone Marrow Transplant 2022; 57:1716-1718. [PMID: 35987913 PMCID: PMC9392432 DOI: 10.1038/s41409-022-01776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
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49
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Jevremovic D, Nanaa A, Geyer SM, Timm M, Azouz H, Hengel C, Reberg A, He R, Viswanatha D, Salama ME, Shi M, Olteanu H, Horna P, Otteson G, Greipp PT, Xie Z, Alkhateeb HB, Hogan W, Litzow M, Patnaik MM, Shah M, Al-Kali A, Nguyen PL. Abnormal CD13/HLA-DR Expression Pattern on Myeloblasts Predicts Development of Myeloid Neoplasia in Patients With Clonal Cytopenia of Undetermined Significance. Am J Clin Pathol 2022; 158:530-536. [PMID: 35938646 PMCID: PMC9535519 DOI: 10.1093/ajcp/aqac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with clonal cytopenia of undetermined significance (CCUS) are at increased risk of developing myeloid neoplasia (MN). We evaluated whether a simple flow cytometry immunophenotyping (FCIP) assay could differentiate the risk of development of MN in patients with CCUS. METHODS Bone marrow aspirates were assessed by FCIP panel in a cohort of 80 patients identified as having CCUS based on next-generation sequencing or cytogenetics from March 2015 to May 2020, with available samples. Flow cytometric assay included CD13/HLA-DR expression pattern on CD34-positive myeloblasts; CD13/CD16 pattern on maturing granulocytic precursors; and aberrant expression of CD2, CD7, or CD56 on CD34-positive myeloblasts. Relevant demographic, comorbidity, and clinical and laboratory data, including the type and extent of genetic abnormalities, were extracted from the electronic health record. RESULTS In total, 17 (21%) patients with CCUS developed MN over the follow-up period (median survival follow-up, 28 months [95% confidence interval, 19-31]). Flow cytometry immunophenotyping abnormalities, including the aberrant pattern of CD13/HLA-DR expression, as detected at the time of the diagnosis of CCUS, were significantly associated with risk of developing MN (hazard ratio, 2.97; P = .006). Additional FCIP parameters associated with the development of MN included abnormal expression of CD7 on myeloblasts and the presence vs absence of any FCIP abnormality. CONCLUSIONS A simple FCIP approach that includes assessment of CD13/HLA-DR pattern on CD34-positive myeloblasts can be useful in identifying patients with CCUS at higher risk of developing MN.
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Affiliation(s)
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Susan M Geyer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michael Timm
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Haya Azouz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Cynthia Hengel
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Gregory Otteson
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA.,Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Zhuoer Xie
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
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50
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Gangat N, Johnson I, McCullough K, Farrukh F, Al-Kali A, Alkhateeb H, Begna K, Mangaonkar A, Litzow M, Hogan W, Shah M, Patnaik M, Pardanani A, Tefferi A. Molecular predictors of response to venetoclax plus hypomethylating agent in treatment-naïve acute myeloid leukemia. Haematologica 2022; 107:2501-2505. [PMID: 35770533 PMCID: PMC9521222 DOI: 10.3324/haematol.2022.281214] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Isla Johnson
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
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