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Saygin C, Zhang P, Stauber J, Aldoss I, Sperling AS, Weeks LD, Luskin MR, Knepper TC, Wanjari P, Wang P, Lager AM, Fitzpatrick C, Segal JP, Gharghabi M, Gurbuxani S, Venkataraman G, Cheng JX, Eisfelder BJ, Bohorquez O, Patel AA, Umesh Nagalakshmi S, Jayaram S, Odenike OM, Larson RA, Godley LA, Arber DA, Gibson CJ, Munshi NC, Marcucci G, Ebert BL, Greally JM, Steidl U, Lapalombella R, Shah BD, Stock W. Acute Lymphoblastic Leukemia with Myeloid Mutations Is a High-Risk Disease Associated with Clonal Hematopoiesis. Blood Cancer Discov 2024; 5:164-179. [PMID: 38150184 PMCID: PMC11061587 DOI: 10.1158/2643-3230.bcd-23-0106] [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: 06/23/2023] [Revised: 10/05/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023] Open
Abstract
Myeloid neoplasms arise from preexisting clonal hematopoiesis (CH); however, the role of CH in the pathogenesis of acute lymphoblastic leukemia (ALL) is unknown. We found that 18% of adult ALL cases harbored TP53, and 16% had myeloid CH-associated gene mutations. ALL with myeloid mutations (MyM) had distinct genetic and clinical characteristics, associated with inferior survival. By using single-cell proteogenomic analysis, we demonstrated that myeloid mutations were present years before the diagnosis of ALL, and a subset of these clones expanded over time to manifest as dominant clones in ALL. Single-cell RNA sequencing revealed upregulation of genes associated with cell survival and resistance to apoptosis in B-ALL with MyM, which responds better to newer immunotherapeutic approaches. These findings define ALL with MyM as a high-risk disease that can arise from antecedent CH and offer new mechanistic insights to develop better therapeutic and preventative strategies. SIGNIFICANCE CH is a precursor lesion for lymphoblastic leukemogenesis. ALL with MyM has distinct genetic and clinical characteristics, associated with adverse survival outcomes after chemotherapy. CH can precede ALL years before diagnosis, and ALL with MyM is enriched with activated T cells that respond to immunotherapies such as blinatumomab. See related commentary by Iacobucci, p. 142.
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Affiliation(s)
- Caner Saygin
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Pu Zhang
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Jacob Stauber
- Albert Einstein College of Medicine–Montefiore Health System, New York, New York
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Adam S. Sperling
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Hematology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Pankhuri Wanjari
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Peng Wang
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Angela M. Lager
- Department of Pathology, University of Chicago, Chicago, Illinois
| | | | - Jeremy P. Segal
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Mehdi Gharghabi
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | | | | | - Jason X. Cheng
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Bart J. Eisfelder
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Oliver Bohorquez
- Albert Einstein College of Medicine–Montefiore Health System, New York, New York
| | - Anand A. Patel
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | | | | | | | - Richard A. Larson
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Lucy A. Godley
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Daniel A. Arber
- Department of Pathology, University of Chicago, Chicago, Illinois
| | | | | | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - John M. Greally
- Albert Einstein College of Medicine–Montefiore Health System, New York, New York
| | - Ulrich Steidl
- Albert Einstein College of Medicine–Montefiore Health System, New York, New York
| | | | | | - Wendy Stock
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
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2
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Crane GM, Geyer JT, Thakral B, Wang SA, Wool GD, Li KD, Davis AR, Boiocchi L, Bosler D, Bueso-Ramos CE, Arber DA, George TI, Bagg A, Hasserjian RP, Orazi A, Hsi ED, Rogers HJ. Predictors of clinical outcome in myeloproliferative neoplasm, unclassifiable: A Bone Marrow Pathology Group study. Am J Clin Pathol 2024:aqae033. [PMID: 38597584 DOI: 10.1093/ajcp/aqae033] [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: 12/12/2023] [Accepted: 03/01/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Myeloproliferative neoplasm, unclassifiable (MPN-U, revised to MPN, not otherwise specified in the fifth edition of the World Health Organization classification) is a heterogeneous category of primary marrow disorders with clinical, morphologic, and/or molecular features that preclude classification as a more specific MPN subtype due to stage at diagnosis, overlapping features between MPN subtypes, or the presence of coexisting disorders. Compared with other MPN subtypes, the contribution of the mutational landscape in MPN-U in conjunction with other clinical and morphologic biomarkers to prognosis has been less well investigated. METHODS We performed a multicenter, retrospective study of MPN-U (94 cases) to better define the clinicopathologic features, genetic landscape, and clinical outcomes, including subgroups of early-stage, advanced-stage, and coexisting disorders. The Dynamic International Prognostic Scoring System (DIPSS) plus scoring system was applied to assess its relevance to MPN-U prognosis. RESULTS Multivariate analysis demonstrated bone marrow blast count and DIPSS plus score as statistically significant in predicting overall survival. Univariate analysis identified additional potential poor prognostic markers, including abnormal karyotype and absence of JAK2 mutation. Secondary mutations were frequent in the subset analyzed by next-generation sequencing (26/37 cases, 70.3%) with a borderline association between high molecular risk mutations and overall survival. CONCLUSIONS This study, as one of the largest of MPN-U studies incorporating both clinicopathologic and molecular data, moves toward identification of biomarkers that better predict prognosis in this heterogeneous category.
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Affiliation(s)
- Genevieve M Crane
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, US
| | - Julia T Geyer
- Department of Pathology, Weill Cornell Medicine, New York, NY, US
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Geoffrey D Wool
- Department of Pathology, University of Chicago, Chicago, IL, US
| | - Ke David Li
- Department of Pathology, University of Utah, Salt Lake City, UT, US
| | - Adam R Davis
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Leonardo Boiocchi
- Department of Pathology, Massachusetts General Hospital, Boston, MA, US
| | - David Bosler
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, US
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, US
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, UT, US
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, US
| | | | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Science Center, El Paso, TX, US
| | - Eric D Hsi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, US
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3
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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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4
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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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5
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Yin CC, Tam W, Walker SM, Kaur A, Ouseph MM, Xie W, K Weinberg O, Li P, Zuo Z, Routbort MJ, Chen S, Medeiros LJ, George TI, Orazi A, Arber DA, Bagg A, Hasserjian RP, Wang SA. STAT5B mutations in myeloid neoplasms differ by disease subtypes but characterize a subset of chronic myeloid neoplasms with eosinophilia and/or basophilia. Haematologica 2023. [PMID: 37981812 DOI: 10.3324/haematol.2023.284311] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Indexed: 11/21/2023] Open
Abstract
STAT5B has been reported as a recurrent mutation in myeloid neoplasms (MNs) with eosinophilia, but the overall frequency and importance across a spectrum of MNs are largely unknown. We conducted a multicenter study on a series of 82 MNs with STAT5B mutations detected by next-generation sequencing. The estimated frequency of STAT5B mutation in MNs was low.
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Affiliation(s)
- C Cameron Yin
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Wayne Tam
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Greenvale, NY
| | - Serena M Walker
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Amandeep Kaur
- Department of Pathology, University of Chicago, Chicago, IL
| | - Madhu M Ouseph
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, NY
| | - Wei Xie
- Department of Pathology and Laboratory Medicine, Oregon Health and Science University, Portland, OR
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Peng Li
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Zhuang Zuo
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark J Routbort
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simon Chen
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - L Jeffrey Medeiros
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Attilio Orazi
- Department of Pathology, Texas Tech University, El Paso, TX
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Sa A Wang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX.
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6
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Foucar K, Bagg A, Bueso-Ramos CE, George T, Hasserjian RP, Hsi ED, Orazi A, Tam W, Wang SA, Weinberg OK, Arber DA. Guide to the Diagnosis of Myeloid Neoplasms: A Bone Marrow Pathology Group Approach. Am J Clin Pathol 2023; 160:365-393. [PMID: 37391178 DOI: 10.1093/ajcp/aqad069] [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: 03/17/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVES The practicing pathologist is challenged by the ever-increasing diagnostic complexity of myeloid neoplasms. This guide is intended to provide a general roadmap from initial case detection, often triggered by complete blood count results with subsequent blood smear review, to final diagnosis. METHODS The integration of hematologic, morphologic, immunophenotypic, and genetic features into routine practice is standard of care. The requirement for molecular genetic testing has increased along with the complexity of test types, the utility of different testing modalities in identifying key gene mutations, and the sensitivity and turnaround time for various assays. RESULTS Classification systems for myeloid neoplasms have evolved to achieve the goal of providing a pathology diagnosis that enhances patient care, outcome prediction, and treatment options for individual patients and is formulated, endorsed, and adopted by hematologists/oncologists. CONCLUSIONS This guide provides diagnostic strategies for all myeloid neoplasm subtypes. Special considerations are provided for each category of testing and neoplasm category, along with classification information, genetic testing requirements, interpretation information, and case reporting recommendations based on the experience of 11 Bone Marrow Pathology Group members.
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Affiliation(s)
- Kathryn Foucar
- Department of Pathology, University of New Mexico, Albuquerque, NM, US
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Tracy George
- Department of Pathology, University of Utah, Salt Lake City, UT, US
| | | | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, US
| | - Attilio Orazi
- Department of Pathology, Texas Tech University, El Paso, TX, US
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Greenvale, NY, US
| | - Sa A Wang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, US
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7
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Weinberg OK, Cantu MD, Gagan J, Madanat YF, Arber DA, Hasserjian RP. Presence but not number of secondary type mutations influences outcome in de novo AML without MDS-associated or recurring cytogenetic abnormalities. EJHaem 2023; 4:760-764. [PMID: 37601841 PMCID: PMC10435713 DOI: 10.1002/jha2.710] [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] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 08/22/2023]
Abstract
A group of gene mutations has been identified to be strongly associated with secondary acute myeloid leukemias (AML) arising from prior myeloid neoplasms. The International Consensus Classification (ICC) and proposed 5th edition of the World Health Organization (WHO) classification differ by inclusion of RUNX1. A recent study suggested that having two or more secondary mutations is associated with a particularly poor prognosis. In a study of 294 de novo AML patients, we found that patients with at least one ICC-defined secondary mutation had shorter survival when compared to those without secondary mutations, and ICC/WHO groups of two or more mutations did not predict for worse outcomes.
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Affiliation(s)
- Olga K. Weinberg
- Department of PathologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Miguel D. Cantu
- Department of PathologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jeffrey Gagan
- Department of PathologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Yazan F. Madanat
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Daniel A. Arber
- Department of PathologyUniversity of ChicagoChicagoIllinoisUSA
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8
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Wang SA, Orazi A, Gotlib J, Reiter A, Tzankov A, Hasserjian RP, Arber DA, Tefferi A. The international consensus classification of eosinophilic disorders and systemic mastocytosis. Am J Hematol 2023. [PMID: 37283522 DOI: 10.1002/ajh.26966] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
Based on new data and increased understanding of disease molecular genetics, the international consensus classification (ICC) has made several changes in the diagnosis and classification of eosinophilic disorders and systemic mastocytosis. Myeloid/lymphoid neoplasms with eosinophilia (M/LN-eo) and gene rearrangements have been renamed as M/LN-eo with tyrosine kinase gene fusions (M/LN-eo-TK). The category has been expanded to include ETV6::ABL1 and FLT3 fusions, and to accept PCM1::JAK2 and its genetic variants as formal members. The overlaps and differences between M/LN-eo-TK and BCR::ABL1-like B-lymphoblastic leukemia (ALL)/de novo T-ALL sharing the same genetic lesions are addressed. Besides genetics, ICC for the first time has introduced bone marrow morphologic criteria in distinguishing idiopathic hypereosinophilia/hypereosinophilic syndrome from chronic eosinophilic leukemia, not otherwise specified. The major diagnostic criteria for systemic mastocytosis (SM) in the ICC remain largely based on morphology, but several minor modifications/refinements have been made in criteria related to diagnosis, subclassification, and assessment of disease burden (B- and C-findings). This review is to focus on the ICC updates related to these disease entities, illustrated through changes related to morphology, molecular genetics, clinical features, prognosis, and treatment. Two practical algorithms are provided in navigating through the diagnosis and classification systems of hypereosinophilia and SM.
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Affiliation(s)
- Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Jason Gotlib
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, California, USA
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexandar Tzankov
- Department of Pathology, Universitätsspital Basel, Basel, Switzerland
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Kirtek T, Chen W, Laczko D, Bagg A, Koduru P, Foucar K, Venable E, Nichols M, Rogers HJ, Tam W, Orazi A, Hsi ED, Hasserjian RP, Wang SA, Arber DA, Weinberg OK. Acute leukemias with complex karyotype show a similarly poor outcome independent of mixed, myeloid or lymphoblastic immunophenotype: A study from the Bone Marrow Pathology Group. Leuk Res 2023; 130:107309. [PMID: 37210875 DOI: 10.1016/j.leukres.2023.107309] [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: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
Mixed phenotype acute leukemia (MPAL) is a heterogenous group of acute leukemias characterized by leukemic blasts that express markers of multiple lineages. The revised 4th edition WHO classification of MPAL excludes AML with myelodysplasia related changes (AML-MRC), including those with complex karyotype (CK), from a diagnosis of MPAL. Abnormal karyotype is frequent in MPAL with the reported rate of CK in MPAL ranging from 19% to 32%. Due its rarity, the clinical and genetic features of MPAL with CK remain poorly characterized. This study aims to further characterize the genetic features of MPAL with CK in comparison to cases of AML and ALL with CK. Cases of de novo MPAL, AML, and B- and T-ALL patients with CK were collected from 8 member institutions of the Bone Marrow Pathology Group. We found no significant difference in overall survival between MPAL with CK compared to AML and ALL with CK. AML with CK was more strongly associated with TP53 mutations, however the presence of TP53 mutations conferred a worse prognosis regardless of lineage. ALL with CK seems to show increased IKZF1 mutation rates which is known to confer a worse prognosis in ALL. Additionally, MPAL with CK showed similarly poor outcomes regardless of whether a lymphoid or myeloid chemotherapy regimen is chosen. Our results suggest that acute leukemias with complex karyotype show a similarly poor outcome regardless of lineage differentiation and that mutation in TP53 confers a poor prognosis in all lineages. Our results support the exclusion of immunophenotypic MPAL with CK from MPAL and appear to confirm the approach proposed in the revised 4th edition WHO to include them as AML with myelodysplasia-related changes and similar myelodysplasia-related AML categories of newer classifications.
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Affiliation(s)
- Timothy Kirtek
- Department of Pathology, UT Southwestern Medical Center, USA
| | - Weina Chen
- Department of Pathology, UT Southwestern Medical Center, USA
| | - Dorottya Laczko
- Department of Pathology, Perelman School of Medicine, Hospital of the University of Pennsylvania, USA
| | - Adam Bagg
- Department of Pathology, University of Pennsylvania, USA
| | - Prasad Koduru
- Department of Pathology, UT Southwestern Medical Center, USA
| | | | - Elise Venable
- Department of Pathology, University of New Mexico, USA
| | - Meredith Nichols
- Department of Pathology, Cleveland Clinic Tomsich Pathology & Laboratory Medicine Institute, USA
| | - Heesun J Rogers
- Department of Pathology, Cleveland Clinic Tomsich Pathology & Laboratory Medicine Institute, USA
| | - Wayne Tam
- Department of Pathology, Weill Cornell Medicine, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Science Center, USA
| | - Eric D Hsi
- Department of Pathology, Wake Forest Baptist Health, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Sa A Wang
- Department of Pathology, UT MD Anderson Cancer Center, USA
| | | | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, USA.
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10
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Weinberg OK, Arber DA, Döhner H, Mullighan CG, Orgel E, Porwit A, Stone RM, Borowitz MJ. The International Consensus Classification of acute leukemias of ambiguous lineage. Blood 2023; 141:2275-2277. [PMID: 36877915 DOI: 10.1182/blood.2022019493] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/26/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center Dallas, TX
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | | | - Etan Orgel
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anna Porwit
- Division of Oncology and Pathology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Michael J Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
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11
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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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12
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Ramia de Cap M, Wu LP, Hirt C, Pihan GA, Patel SS, Tam W, Bueso-Ramos CE, Kanagal-Shamanna R, Raess PW, Siddon A, Narayanan D, Morgan EA, Pinkus GS, Mason EF, Hsi ED, Rogers HJ, Toth L, Foucar K, Hurwitz SN, Bagg A, Rets A, George TI, Orazi A, Arber DA, Hasserjian RP, Weinberg OK. Myeloid sarcoma with NPM1 mutation may be clinically and genetically distinct from AML with NPM1 mutation: a study from the Bone Marrow Pathology Group. Leuk Lymphoma 2023:1-9. [PMID: 36960680 DOI: 10.1080/10428194.2023.2185091] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Myeloid sarcoma (MS) is currently considered equivalent to de novo acute myeloid leukemia (AML); however, the relationship between these entities is poorly understood. This retrospective multi-institutional cohort study compared 43 MS with NPM1 mutation to 106 AML with NPM1 mutation. Compared to AML, MS had more frequent cytogenetic abnormalities including complex karyotype (p = .009 and p = .007, respectively) and was enriched in mutations of genes involved in histone modification, including ASXL1 (p = .007 and p = .008, respectively). AML harbored a higher average number of gene mutations (p = .002) including more frequent PTPN11 mutations (p < .001) and mutations of DNA-methylating genes including DNMT3A and IDH1 (both p < .001). MS had significantly shorter overall survival (OS) than AML (median OS: 44.9 vs. 93.2 months, respectively, p = .037). MS with NPM1 mutation has a unique genetic landscape, and poorer OS, compared to AML with NPM1 mutation.
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Affiliation(s)
- Maximiliano Ramia de Cap
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- North Bristol NHS Trust, Bristol, UK
| | - Leo P Wu
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christian Hirt
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - German A Pihan
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Wayne Tam
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Philipp W Raess
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | | | - Damodaran Narayanan
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth A Morgan
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Geraldine S Pinkus
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Emily F Mason
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric D Hsi
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Laura Toth
- Department of Pathology, The University of New Mexico, Albuquerque, NM, USA
| | - Kathryn Foucar
- Department of Pathology, The University of New Mexico, Albuquerque, NM, USA
| | | | - Adam Bagg
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anton Rets
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Tracy I George
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Robert P Hasserjian
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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13
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Arber DA, Hasserjian RP, Orazi A. Moving toward more molecular classifications of myelodysplastic syndrome and acute myeloid leukemia. Am J Hematol 2023; 98:377-378. [PMID: 36565454 DOI: 10.1002/ajh.26820] [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: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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14
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Thiele J, Kvasnicka HM, Orazi A, Gianelli U, Gangat N, Vannucchi AM, Barbui T, Arber DA, Tefferi A. The international consensus classification of myeloid neoplasms and acute leukemias: Myeloproliferative neoplasms. Am J Hematol 2023; 98:544-545. [PMID: 36600640 DOI: 10.1002/ajh.26821] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
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15
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Al-Ghamdi YA, Lake J, Bagg A, Thakral B, Wang SA, Bueso-Ramos C, Masarova L, Verstovsek S, Rogers HJ, Hsi ED, Gralewski JH, Chabot-Richards D, George TI, Rets A, Hasserjian RP, Weinberg OK, Parilla M, Arber DA, Padilla O, Orazi A, Tam W. Triple-Negative Primary Myelofibrosis: A Bone Marrow Pathology Group Study. Mod Pathol 2023; 36:100016. [PMID: 36788093 DOI: 10.1016/j.modpat.2022.100016] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm driven by canonical gene mutations in JAK2, CALR, or MPL in >80% of the cases. PMF that lacks these canonical alterations is termed triple-negative PMF (TN-PMF). The pathologic and genetic characteristics of TN-PMF compared with those of conventional PMF with canonical driver mutations (DM-PMF) have not been well studied. We aimed to identify clinicopathologic and molecular genetic differences between patients with TN-PMF (n = 56) and DM-PMF (n = 89), all of whom fulfilled the 2016 World Health Organization diagnostic criteria for PMF. Compared with the control group, patients in the TN-PMF group were more likely to have thrombocytopenia and less likely to have organomegaly. The bone marrow in patients with TN-PMF showed fewer granulocytic elements and more frequent dyserythropoiesis. Cytogenetic analysis showed a higher incidence of trisomy 8. Targeted next-generation sequencing revealed a lower frequency of ASXL1 mutations but enrichment of ASXL1/SRSF2 comutations. Our findings demonstrated several clinicopathologic and molecular differences between TN-PMF and DM-PMF. These findings, particularly the observed mutation profile characterized by a higher frequency of ASXL1 and SRSF2 comutation, suggest that at least a subset of TN-PMF may be pathogenetically different from DM-PMF, with potential prognostic implications.
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Affiliation(s)
- Yahya A Al-Ghamdi
- Department of Pathology, Umm Al-Qura University, Makkah, Saudi Arabia; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Jonathan Lake
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lucia Masarova
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jonathon H Gralewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Anton Rets
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Megan Parilla
- Department of Pathology, Loyola University, Maywood, Illinois
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Osvaldo Padilla
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York.
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16
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Suknuntha K, Geyer JT, Patel KP, Weinberg OK, Rogers HJ, Lake JI, Lauridsen L, Patel JL, Kluk MJ, Arber DA, Hsi ED, Bagg A, Bueso-Ramos C, Orazi A. Clinicopathologic characteristics of myeloproliferative neoplasms with JAK2 exon 12 mutation. Leuk Res 2023; 127:107033. [PMID: 36774789 DOI: 10.1016/j.leukres.2023.107033] [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: 11/10/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
The presence of JAK2 exon 12 mutation was included by the 2016 World Health Organization (WHO) Classification as one of the major criteria for diagnosing polycythemia vera (PV). Few studies have evaluated the clinical presentation and bone marrow morphology of these patients and it is unclear if these patients fulfill the newly published criteria of 5th edition WHO or The International Consensus Classification (ICC) criteria for PV. Forty-three patients with JAK2 exon 12 mutations were identified from the files of 7 large academic institutions. Twenty patients had complete CBC and BM data at disease onset. Fourteen patients met the diagnostic criteria for PV and the remaining six patients were diagnosed as MPN-U. At diagnosis, 9/14 patients had normal WBC and platelet counts (isolated erythrocytosis/IE subset); while 5/14 had elevated WBC and/or platelets (polycythemic /P subset). We found that hemoglobin and hematocrit tended to be lower in the polycythemia group. Regardless of presentation (P vs IE), JAK2 deletion commonly occurred in amino acids 541-544 (62 %). MPN-U patients carried JAK2 exon 12 mutation, but did not fulfill the criteria for PV. Half of the patients had hemoglobin/hematocrit below the diagnostic threshold for PV, but showed increased red blood cell count with low mean corpuscular volume (56-60 fL). Three cases lacked evidence of bone marrow hypercellularity. In summary, the future diagnostic criteria for PV may require a modification to account for the variant CBC and BM findings in some patients with JAK2 exon 12 mutation.
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Affiliation(s)
- Kran Suknuntha
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States; Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand.
| | - Julia T Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States.
| | - Keyur Pravinchandra Patel
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Heesun J Rogers
- Department of Pathology, Cleveland Clinic, Cleveland, OH, United States.
| | - Jonathan I Lake
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Luke Lauridsen
- Department of Pathology, University of Chicago, Chicago, IL, United States.
| | - Jay L Patel
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, United States.
| | - Michael J Kluk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States.
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, United States.
| | - Eric D Hsi
- Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, NC 27157, United States.
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Carlos Bueso-Ramos
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand.
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, United States.
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17
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Arber DA, Campo E, Jaffe ES. Advances in the Classification of Myeloid and Lymphoid Neoplasms. Virchows Arch 2023; 482:1-9. [PMID: 36586001 DOI: 10.1007/s00428-022-03487-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Daniel A Arber
- University of Chicago, 5841 S. Maryland Ave MC3081, Rm S-329, Chicago, IL, 60637, USA.
| | - Elias Campo
- Hematopathology Section, Hospital Clinic of Barcelona, Institute of BIomedical Research August Pi I Sunyer, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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18
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Orazi A, Hasserjian RP, Cazzola M, Döhner H, Tefferi A, Arber DA. International Consensus Classification for myeloid neoplasms at-a-glance. Am J Hematol 2023; 98:6-10. [PMID: 36314608 DOI: 10.1002/ajh.26772] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mario Cazzola
- Department of Hematology, University of Pavia, Pavia, Italy
| | - Hartmut Döhner
- Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Ayalew Tefferi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
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19
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Cantu MD, Kanagal-Shamanna R, Wang SA, Kadia T, Bueso-Ramos CE, Patel SS, Geyer JT, Tam W, Madanat Y, Li P, George TI, Nichols MM, Rogers HJ, Liu YC, Aggarwal N, Kurzer JH, Maracaja DLV, Hsi ED, Zaiem F, Babu D, Foucar K, Laczko D, Bagg A, Orazi A, Arber DA, Hasserjian RP, Weinberg OK. Clinicopathologic and Molecular Analysis of Normal Karyotype Therapy-Related and De Novo Acute Myeloid Leukemia: A Multi-Institutional Study by the Bone Marrow Pathology Group. JCO Precis Oncol 2023; 7:e2200400. [PMID: 36689697 DOI: 10.1200/po.22.00400] [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] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Therapy-related acute myeloid leukemias (t-AML) are a heterogenous group of aggressive neoplasms that arise following exposure to cytotoxic chemotherapy and/or ionizing radiation. Many therapy-related myeloid neoplasms (t-MN) are associated with distinct chromosomal aberrations and/or TP53 alterations, but little is known about the clinicopathologic and molecular features of normal karyotype t-AML (NK-t-AML) and whether this t-MN subtype is distinctly different from NK de novo AML (NK-dn-AML). METHODS This multi-institutional study by the Bone Marrow Pathology Group retrospectively evaluated clinicopathologic and molecular characteristics of 335 patients with NK-AML, comprising 105 t-AML and 230 dn-AML cases. RESULTS Patients with t-AML compared with dn-AML exhibit significantly shorter overall survival (OS; median months: 17.6 v 44.2; P < .0001) and relapse-free survival (RFS; median months: 9.1 v 19.2; P = .0018). Frequency of NPM1, FLT3, KRAS, and GATA2 mutations were significantly different in NK-t-AML compared with NK-dn-AML (NPM1 35% v 49%; P = .0493; FLT3 23% v 36%; P = 0494; KRAS 12% v 5%; P = .0465; GATA2 9% v 2% P = .0105), while TP53 mutations were rare. Patients with t-AML more often stratified into intermediate or adverse 2017 ELN genetic risk groups. Favorable ELN risk predicted favorable OS (hazard ratio [HR], 0.4056; 95% CI, 0 to 0.866; P = .020) and RFS (HR, 0.355; 95% CI, 0 to 0.746; P = .006). Among all patients with NK-AML, stem-cell transplant and favorable ELN risk both significantly affected RFS, while therapy-relatedness and age had a borderline significant impact on OS (HR, 1.355; 95% CI, 0.975 to 1.882; P = .070). CONCLUSION To our knowledge, this is the largest study to date to comprehensively evaluate NK-t-AML and provides a framework that may inform our understanding of NK-t-AML disease biology and could potentially help guide therapeutic management and improved disease classification in t-MNs that lack cytogenetic aberrations.
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Affiliation(s)
- Miguel D Cantu
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Sa A Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tapan Kadia
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Wayne Tam
- Weill Cornell Medical Center, New York, NY
| | - Yazan Madanat
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Peng Li
- University of Utah, Salt Lake City, UT
| | | | | | | | | | - Nidhi Aggarwal
- UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | - Eric D Hsi
- Wake Forest Baptist Health, Winston-Salem, NC
| | | | | | | | - Dorottya Laczko
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adam Bagg
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Attilio Orazi
- Texas Tech University Health Science Center, St Lubbock, TX
| | | | | | - Olga K Weinberg
- The University of Texas Southwestern Medical Center, Dallas, TX
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20
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Prakash S, Arber DA, Bueso-Ramos C, Hasserjian RP, Orazi A. Advances in myelodysplastic/myeloproliferative neoplasms. Virchows Arch 2023; 482:69-83. [PMID: 36469102 DOI: 10.1007/s00428-022-03465-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 08/18/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/07/2022]
Abstract
The myelodysplastic syndrome/myeloproliferative neoplasms (MDS/MPN) category includes a heterogeneous group of diseases characterized by the co-occurrence of clinical and pathologic features of both myelodysplastic and myeloproliferative neoplasms. The recently published International Consensus Classification of myeloid neoplasms revised the entities included in the MDS/MPN category as well as criteria for their diagnosis. In addition to the presence of one or more increased peripheral blood cell counts as evidence of myeloproliferative features, concomitant cytopenia as evidence of ineffective hematopoiesis is now an explicit requirement to diagnose the diseases included in this category. The increasing availability of modern gene sequencing has allowed better understanding of the biologic characteristics of these myeloid neoplasms. The presence of specific mutations in the appropriate clinicopathologic context is now included in the diagnostic criteria for some of MDS/MPN entities. In this review, we highlight what has changed in the diagnostic criteria of MDS/MPN from the WHO 2016 classification while providing practical guidance in diagnosing these diseases.
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Affiliation(s)
- Sonam Prakash
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Carlos Bueso-Ramos
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA.
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21
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Tzankov A, Reichard KK, Hasserjian RP, Arber DA, Orazi A, Wang SA. Updates on eosinophilic disorders. Virchows Arch 2023; 482:85-97. [PMID: 36068374 DOI: 10.1007/s00428-022-03402-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 01/24/2023]
Abstract
This review addresses changes and updates in eosinophilic disorders under the International Consensus Classification (ICC). The previous category of myeloid/lymphoid neoplasm with eosinophilia (M/LN-eo) and a specific gene rearrangement is changed to M/LN-eo with tyrosine kinase gene fusions to reflect the underlying genetic lesions. Two new members, M/LN-eo with ETV6::ABL1 fusion and M/LN-eo with various FLT3 fusions, have been added to the category; and M/LN-eo with PCM1::JAK2 and its genetic variants ETV6::JAK2 and BCR::JAK2 are recognized as a formal entity from their former provisional status. The updated understanding of the clinical and molecular genetic features of PDGFRA, PDGFRB and FGFR1 neoplasms is summarized. Clear guidance as to how to distinguish these fusion gene-associated disorders from the overlapping entities of Ph-like B-acute lymphoblastic leukemia (ALL), de novo T-ALL, and systemic mastocytosis is provided. Bone marrow morphology now constitutes one of the diagnostic criteria of chronic eosinophilic leukemia, NOS (CEL, NOS), and idiopathic hypereosinophilia/hypereosinophilic syndrome (HE/HES), facilitating the separation of a true myeloid neoplasm with characteristic eosinophilic proliferation from those of unknown etiology and not attributable to a myeloid neoplasm.
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Affiliation(s)
- Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, NY, Rochester, USA
| | | | - Daniel A Arber
- Department of Pathology, University of Chicago, IL, Chicago, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Sa A Wang
- Department of Hematopathology, Division of Pathology, The University of Texas MD Anderson Cancer Center, TX, Houston, USA.
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22
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Weinberg OK, Porwit A, Orazi A, Hasserjian RP, Foucar K, Duncavage EJ, Arber DA. The International Consensus Classification of acute myeloid leukemia. Virchows Arch 2023; 482:27-37. [PMID: 36264379 DOI: 10.1007/s00428-022-03430-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 08/18/2022] [Revised: 10/05/2022] [Accepted: 10/15/2022] [Indexed: 01/24/2023]
Abstract
Acute myeloid leukemias (AMLs) are overlapping hematological neoplasms associated with rapid onset, progressive, and frequently chemo-resistant disease. At diagnosis, classification and risk stratification are critical for treatment decisions. A group with expertise in the clinical, pathologic, and genetic aspects of these disorders developed the International Consensus Classification (ICC) of acute leukemias. One of the major changes includes elimination of AML with myelodysplasia-related changes group, while creating new categories of AML with myelodysplasia-related cytogenetic abnormalities, AML with myelodysplasia-related gene mutations, and AML with mutated TP53. Most of recurrent genetic abnormalities, including mutations in NPM1, that define specific subtypes of AML have a lower requirement of ≥ 10% blasts in the bone marrow or blood, and a new category of MDS/AML is created for other case types with 10-19% blasts. Prior therapy, antecedent myeloid neoplasms or underlying germline genetic disorders predisposing to the development of AML are now recommended as qualifiers to the initial diagnosis of AML. With these changes, classification of AML is updated to include evolving genetic, clinical, and morphologic findings.
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Affiliation(s)
- Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, BioCenter, 2230 Inwood Rd, Dallas, TX, EB03.220G75235, USA.
| | - Anna Porwit
- Division of Oncology and Pathology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, El Paso, TX, USA
| | | | - Kathryn Foucar
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Eric J Duncavage
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
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23
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Thiele J, Kvasnicka HM, Orazi A, Gianelli U, Gangat N, Vannucchi AM, Barbui T, Arber DA, Tefferi A. The international consensus classification of myeloid neoplasms and acute Leukemias: myeloproliferative neoplasms. Am J Hematol 2023; 98:166-179. [PMID: 36200127 DOI: 10.1002/ajh.26751] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 02/04/2023]
Abstract
A group of international experts, including hematopathologists, oncologists, and geneticists were recently summoned (September 2021, Chicago, IL, USA) to update the 2016/17 World Health Organization classification system for hematopoietic tumors. After careful deliberation, the group introduced the new International Consensus Classification (ICC) for Myeloid Neoplasms and Acute Leukemias. This current in-depth review focuses on the ICC-2022 category of JAK2 mutation-prevalent myeloproliferative neoplasms (MPNs): essential thrombocythemia, polycythemia vera, primary myelofibrosis, and MPN, unclassifiable. The ICC MPN subcommittee chose to preserve the primary role of bone marrow morphology in disease classification and diagnostics, while also acknowledging the complementary role of genetic markers for establishing clonality, facilitating MPN subtype designation, and disease prognostication.
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Affiliation(s)
- Jürgen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | | | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Umberto Gianelli
- Department of Health Sciences and S.C. Anatomia Patologica, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alessandro M Vannucchi
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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Duncavage EJ, Bagg A, Hasserjian RP, DiNardo CD, Godley LA, Iacobucci I, Jaiswal S, Malcovati L, Vannucchi AM, Patel KP, Arber DA, Arcila ME, Bejar R, Berliner N, Borowitz MJ, Branford S, Brown AL, Cargo CA, Döhner H, Falini B, Garcia-Manero G, Haferlach T, Hellström-Lindberg E, Kim AS, Klco JM, Komrokji R, Lee-Cheun Loh M, Loghavi S, Mullighan CG, Ogawa S, Orazi A, Papaemmanuil E, Reiter A, Ross DM, Savona M, Shimamura A, Skoda RC, Solé F, Stone RM, Tefferi A, Walter MJ, Wu D, Ebert BL, Cazzola M. Genomic profiling for clinical decision making in myeloid neoplasms and acute leukemia. Blood 2022; 140:2228-2247. [PMID: 36130297 PMCID: PMC10488320 DOI: 10.1182/blood.2022015853] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [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: 06/06/2022] [Accepted: 08/27/2022] [Indexed: 11/20/2022] Open
Abstract
Myeloid neoplasms and acute leukemias derive from the clonal expansion of hematopoietic cells driven by somatic gene mutations. Although assessment of morphology plays a crucial role in the diagnostic evaluation of patients with these malignancies, genomic characterization has become increasingly important for accurate diagnosis, risk assessment, and therapeutic decision making. Conventional cytogenetics, a comprehensive and unbiased method for assessing chromosomal abnormalities, has been the mainstay of genomic testing over the past several decades and remains relevant today. However, more recent advances in sequencing technology have increased our ability to detect somatic mutations through the use of targeted gene panels, whole-exome sequencing, whole-genome sequencing, and whole-transcriptome sequencing or RNA sequencing. In patients with myeloid neoplasms, whole-genome sequencing represents a potential replacement for both conventional cytogenetic and sequencing approaches, providing rapid and accurate comprehensive genomic profiling. DNA sequencing methods are used not only for detecting somatically acquired gene mutations but also for identifying germline gene mutations associated with inherited predisposition to hematologic neoplasms. The 2022 International Consensus Classification of myeloid neoplasms and acute leukemias makes extensive use of genomic data. The aim of this report is to help physicians and laboratorians implement genomic testing for diagnosis, risk stratification, and clinical decision making and illustrates the potential of genomic profiling for enabling personalized medicine in patients with hematologic neoplasms.
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Affiliation(s)
- Eric J. Duncavage
- Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Courtney D. DiNardo
- Division of Cancer Medicine, Department of Leukemia, MD Anderson Cancer Center, Houston, TX
| | - Lucy A. Godley
- Section of Hematology and Oncology, Departments of Medicine and Human Genetics, The University of Chicago, Chicago, IL
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Luca Malcovati
- Department of Molecular Medicine, University of Pavia & Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Alessandro M. Vannucchi
- Department of Hematology, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Keyur P. Patel
- Division of Pathology/Lab Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Maria E. Arcila
- Department of Pathology, Memorial Sloan Lettering Cancer Center, New York, NY
| | - Rafael Bejar
- Division of Hematology and Oncology, University of California San Diego, La Jolla, CA
| | - Nancy Berliner
- Division of Hematology, Brigham and Women’s Hospital, Harvard University, Boston, MA
| | - Michael J. Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
- Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Susan Branford
- Department of Genetics and Molecular Pathology, Center for Cancer Biology, SA Pathology, Adelaide, Australia
| | - Anna L. Brown
- Department of Pathology, South Australia Heath Alliance, Adelaide, Australia
| | - Catherine A. Cargo
- Haematological Malignancy Diagnostic Service, St James’s University Hospital, Leeds, United Kingdom
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Brunangelo Falini
- Department of Hematology, CREO, University of Perugia, Perugia, Italy
| | | | | | - Eva Hellström-Lindberg
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annette S. Kim
- Department of Pathology, Brigham and Women’s Hospital, Harvard University, Boston, MA
| | - Jeffery M. Klco
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Mignon Lee-Cheun Loh
- Department of Pediatrics, Ben Towne Center for Childhood Cancer Research, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Sanam Loghavi
- Division of Pathology/Lab Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Seishi Ogawa
- University of Kyoto School of Medicine, Kyoto, Japan
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX
| | | | - Andreas Reiter
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - David M. Ross
- Haematology Directorate, SA Pathology, Adelaide, Australia
| | - Michael Savona
- Department of Medicine, Vanderbilt University, Nashville, TN
| | - Akiko Shimamura
- Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Radek C. Skoda
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Francesc Solé
- MDS Group, Institut de Recerca contra la Leucèmia Josep Carreras, Barcelona, Spain
| | - Richard M. Stone
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - David Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Benjamin L. Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mario Cazzola
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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25
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Swerdlow SH, Campo E, Arber DA, Cazzola M, Cook JR, Döhner H, Dreyling M, Hasserjian RP, Jaffe ES, Orazi A, Quintanilla-Martinez L, Scott DW, Tefferi A, Winter JN, Zelenetz AD. Response to "The WHO classification of haematolymphoid tumours" (Editorial). Leukemia 2022; 36:2748-2749. [PMID: 36030304 DOI: 10.1038/s41375-022-01689-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
| | - Elias Campo
- Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | - Martin Dreyling
- Ludwig Maximilians University Hospital, Department of Medicine III, Munich, Germany
| | | | - Elaine S Jaffe
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | | | | | | | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrew D Zelenetz
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
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26
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Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Branford S, Bueso-Ramos CE, Cortes JE, Dal Cin P, DiNardo CD, Dombret H, Duncavage EJ, Ebert BL, Estey EH, Facchetti F, Foucar K, Gangat N, Gianelli U, Godley LA, Gökbuget N, Gotlib J, Hellström-Lindberg E, Hobbs GS, Hoffman R, Jabbour EJ, Kiladjian JJ, Larson RA, Le Beau MM, Loh MLC, Löwenberg B, Macintyre E, Malcovati L, Mullighan CG, Niemeyer C, Odenike OM, Ogawa S, Orfao A, Papaemmanuil E, Passamonti F, Porkka K, Pui CH, Radich JP, Reiter A, Rozman M, Rudelius M, Savona MR, Schiffer CA, Schmitt-Graeff A, Shimamura A, Sierra J, Stock WA, Stone RM, Tallman MS, Thiele J, Tien HF, Tzankov A, Vannucchi AM, Vyas P, Wei AH, Weinberg OK, Wierzbowska A, Cazzola M, Döhner H, Tefferi A. International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data. Blood 2022; 140:1200-1228. [PMID: 35767897 PMCID: PMC9479031 DOI: 10.1182/blood.2022015850] [Citation(s) in RCA: 750] [Impact Index Per Article: 375.0] [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: 05/03/2022] [Accepted: 06/16/2022] [Indexed: 02/02/2023] Open
Abstract
The classification of myeloid neoplasms and acute leukemias was last updated in 2016 within a collaboration between the World Health Organization (WHO), the Society for Hematopathology, and the European Association for Haematopathology. This collaboration was primarily based on input from a clinical advisory committees (CACs) composed of pathologists, hematologists, oncologists, geneticists, and bioinformaticians from around the world. The recent advances in our understanding of the biology of hematologic malignancies, the experience with the use of the 2016 WHO classification in clinical practice, and the results of clinical trials have indicated the need for further revising and updating the classification. As a continuation of this CAC-based process, the authors, a group with expertise in the clinical, pathologic, and genetic aspects of these disorders, developed the International Consensus Classification (ICC) of myeloid neoplasms and acute leukemias. Using a multiparameter approach, the main objective of the consensus process was the definition of real disease entities, including the introduction of new entities and refined criteria for existing diagnostic categories, based on accumulated data. The ICC is aimed at facilitating diagnosis and prognostication of these neoplasms, improving treatment of affected patients, and allowing the design of innovative clinical trials.
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Affiliation(s)
| | - Attilio Orazi
- Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | | | | | | | | | - Sa A Wang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adam Bagg
- University of Pennsylvania, Philadelphia, PA
| | - Tiziano Barbui
- Clinical Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | | | | | | | - Hervé Dombret
- Université Paris Cité, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | | | | | | | - Jason Gotlib
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - Jean-Jacques Kiladjian
- Université Paris Cité, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kimmo Porkka
- Helsinki University Central Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | | | | | | | | | | | | | | | - Akiko Shimamura
- Dana-Farber Cancer Institute, Boston, MA
- Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Hwei-Fang Tien
- National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | - Paresh Vyas
- University of Oxford, Oxford, United Kingdom
| | - Andrew H Wei
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
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27
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Kelley JT, Fuller LD, Lai KK, Yantiss RK, Dzedzik S, Alapat D, Mashayekhi A, Alpert L, Gonzalez RS, Owens SR, Arber DA, Lamps LW. Gastrointestinal, Hepatic and Pancreatobiliary Involvement by Plasma Cell Neoplasms: Clinicopathologic Correlations in a Retrospective Cohort of 116 Cases. Histopathology 2022; 81:742-757. [PMID: 35984728 DOI: 10.1111/his.14778] [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: 04/29/2022] [Revised: 06/23/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS Plasma cell neoplasms (PCNs) may involve the gastrointestinal (GI) tract in two forms: plasmacytoma (PC), an isolated lesion which lacks marrow involvement, and extramedullary myeloma (EMM). However, previous literature on PCNs involving the GI tract, liver and pancreas is limited. We evaluated the clinicopathologic features of the largest series of GI PCNs to date. METHODS AND RESULTS Six institutional archives were searched for GI, liver and pancreas cases involved by PCNs. Medical records were reviewed for clinical and imaging features. Histopathologic features evaluated included involved organ, tumor grade and marrow involvement. Overall, 116 cases from 102 patients were identified. Tumors most presented as incidental findings (29%). The liver was most involved (47%), and masses/polyps (29%) or ulcers (21%) were most common findings. Most cases had high-grade morphology (55%). The majority (74%) of GI PCNs were classified as EMM due to the presence of marrow involvement at some point during the disease course, occurring within a year of marrow diagnosis in 46% of patients. PC was classified in 26% of patients due to the lack of marrow involvement. Most (70%) patients died from disease within 10 years (median 14.1) of diagnosis and more than half (58%) died within 6 months. CONCLUSION PC and EMM involving the GI tract, liver and pancreas have a wide range of clinicopathologic presentations. Tumors may occur virtually anywhere in the GI tract or abdomen and may precede the diagnosis of marrow involvement. Both GI PC and EMM are associated with a poor prognosis.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Keith K Lai
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Siarhei Dzedzik
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Azin Mashayekhi
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Scott R Owens
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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28
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Wang P, Segal J, Drazer MW, Venkataraman G, Arber DA, Gurbuxani S. NPM1
exon 5 mutations in acute myeloid leukemia: Implications in diagnosis and minimal residual monitoring. eJHaem 2022; 3:962-965. [PMID: 36051025 PMCID: PMC9421992 DOI: 10.1002/jha2.445] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Peng Wang
- Department of Pathology University of Chicago Chicago Illinois USA
| | - Jeremy Segal
- Department of Pathology University of Chicago Chicago Illinois USA
| | | | | | - Daniel A. Arber
- Department of Pathology University of Chicago Chicago Illinois USA
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29
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Arber DA, Hasserjian RP, Orazi A, Mathews V, Roberts AW, Schiffer CA, Roug AS, Cazzola M, Döhner H, Tefferi A. Classification of myeloid neoplasms/acute leukemia: Global perspectives and the international consensus classification approach. Am J Hematol 2022; 97:514-518. [PMID: 35179244 PMCID: PMC9303333 DOI: 10.1002/ajh.26503] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel A. Arber
- Department of Pathology University of Chicago Chicago Illinois USA
| | - Robert P. Hasserjian
- Department of Pathology Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Attilio Orazi
- Department of Pathology Texas Tech University Health Sciences Center El Paso Texas USA
| | - Vikram Mathews
- Department of Hematology Christian Medical College Vellore Tamil Nadu India
| | - Andrew W. Roberts
- Department of Clinical Hematology Royal Melbourne Hospital and Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Charles A. Schiffer
- Department of Oncology, Karmanos Cancer Institute Wayne State University Detroit Michigan USA
| | | | - Mario Cazzola
- Department of Molecular Medicine Fondazione IRCCS Policlinico San Matteo and University of Pavia Pavia Italy
| | - Hartmut Döhner
- Department of Internal Medicine University of Ulm Ulm Germany
| | - Ayalew Tefferi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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30
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Siddiqui F, Perez Silos V, Karube K, Yasin Goksu S, Nandakumar S, Saygin C, Onajin O, Prabu SS, Gurbuxani S, Arber DA, Tjota M, Segal J, Smith SM, Murga-Zamalloa CA, Venkataraman G. B-cell lymphoma-2 (BCL2) downregulation is a useful feature -supporting a neoplastic phenotype in mature T-cell lymphomas. Hum Pathol 2022; 125:48-58. [PMID: 35452696 DOI: 10.1016/j.humpath.2022.04.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
Normal T-cells express high levels of BCL2 protein, data regarding BCL2 expression status and its diagnostic utility in T-cell lymphoma is scarce. We evaluated BCL2 expression in a series of mature T-cell lymphoproliferations including indolent and more recently recognized entities (follicular helper T-cell (TFH) lymphomas). Sixty-six neoplastic biopsies (60 patients) representing mature nodal, extranodal and leukemia T-cell neoplasms were collected from three institutes (2 US and 1 Japan) and were compared with reactive T-cells in 8 benign tissues/blood and 9 T-cell rich B-cell proliferations. BCL2 immunostaining was performed and scored based on intensity weighted H-score (0-300). Next generation sequencing (5 cases), BCL2 gene sequencing, and real time-PCR (3 cases) were conducted. Association of H-score with overall survival (using proportional hazards modeling) was assessed in non-leukemic T-cell lymphoproliferations (TCL). Most TCLs showed significantly downregulated median BCL2 H-score (125, range 18-300) with the exception of T-cell prolymphocytic leukemia (T-PLL) and hepatosplenic T-cell lymphoma (HSTL) both of which showed uniform strong retention of BCL2 as did the 8 reactive tissues (median H-score 280; p=0.000). Notably all TFH lymphoma CD4 neoplastic T-cells, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) CD8 adipocyte-rimming T-cells and T-cell large lymphocyte leukemia (T-LGLL) with pathogenic STAT5B and TP53 mutation showed BCL2 downregulation. No BCL2 mutations were observed by NGS or sequencing with decreased BCL2 mRNA transcripts by real-time PCR. BCL2 downregulation is pervasive among many T-cell lymphoproliferations and unrelated to any mutations. There is utility for BCL2 immunostaining in some challenging situations as discussed in manuscript.
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MESH Headings
- Down-Regulation
- Humans
- Leukemia
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/pathology
- Phenotype
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
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Affiliation(s)
- Faiza Siddiqui
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | | | - Kennosuke Karube
- Department of Pathology and Cell Biology, University of the Ryukyus, Okinawa, Japan
| | | | | | - Caner Saygin
- The University of Chicago Medicine, Departments of Medicine, Section of Hematology/Oncology, USA
| | - Oluwakemi Onajin
- The University of Chicago Medicine, Departments of Dermatology, USA
| | | | - Sandeep Gurbuxani
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Daniel A Arber
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Melissa Tjota
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Jeremy Segal
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA
| | - Sonali M Smith
- The University of Chicago Medicine, Departments of Medicine, Section of Hematology/Oncology, USA
| | | | - Girish Venkataraman
- The University of Chicago Medicine, Departments of Pathology, Section of Hematopathology, USA.
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Kaumeyer BA, Fidai SS, Thakral B, Wang SA, Arber DA, Cheng JX, Gurbuxani S, Venkataraman G. GLUT1 Immunohistochemistry Is a Highly Sensitive and Relatively Specific Marker for Erythroid Lineage in Benign and Malignant Hematopoietic Tissues. Am J Clin Pathol 2022; 158:228-234. [PMID: 35311938 DOI: 10.1093/ajcp/aqac034] [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: 11/16/2021] [Accepted: 02/21/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Glucose transporter 1 (GLUT1), a glucose transporter, is an abundant protein in erythrocytes with expression beginning early in erythropoiesis. We sought to evaluate the utility of GLUT1 immunohistochemistry (IHC) as a diagnostic marker for identifying erythroid differentiation in hematopoietic tissues, including neoplastic erythroid proliferations. METHODS A variety of benign and neoplastic bone marrow biopsy specimens containing variable proportions of erythroid precursors were selected (n = 46, including 36 cases of leukemia). GLUT1 IHC was performed using a commercially available polyclonal antibody. Each case was evaluated for staining of erythroid precursors, nonerythroid hematopoietic cells, and blasts. A GATA1/GLUT1 double stain was performed on one case to confirm coexpression of GLUT1 on early erythroid precursors. Staining was compared with other erythroid markers, including glycophorin C. RESULTS GLUT1 demonstrated strong membranous staining in erythroid precursors of all cases, which was restricted largely to the erythroid lineage. Of the 36 leukemia cases, all 6 cases of pure erythroid leukemia and both cases of therapy-related acute myeloid leukemia with erythroid differentiation showed positive GLUT1 staining in blasts. Otherwise, only lymphoblasts in B-lymphoblastic leukemia showed weak to moderate granular cytoplasmic staining (four of five cases). CONCLUSIONS GLUT1 IHC is a highly sensitive and relatively specific marker for erythroid lineage in benign and neoplastic bone marrow biopsy specimens.
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Affiliation(s)
| | - Shiraz S Fidai
- Department of Pathology, University of Chicago, Chicago, IL, USA
- Department of Pathology and Laboratory Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA
| | - Beenu Thakral
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Jason X Cheng
- Department of Pathology, University of Chicago, Chicago, IL, USA
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Tang G, Tam W, Short NJ, Bose P, Wu D, Hurwitz SN, Bagg A, Rogers HJ, Hsi ED, Quesada AE, Wang W, Miranda RN, Bueso-Ramos CE, Medeiros LJ, Nardi V, Hasserjian RP, Arber DA, Orazi A, Foucar K, Wang SA. Myeloid/lymphoid neoplasms with FLT3 rearrangement. Mod Pathol 2021; 34:1673-1685. [PMID: 33990705 DOI: 10.1038/s41379-021-00817-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022]
Abstract
Myeloid/lymphoid neoplasms (M/LN) with 13q12/FLT3 rearrangement have been suggested as candidates for possible inclusion in the World Health Organization classification group of M/LN with eosinophilia (M/LN-eo). We report 12 patients with confirmed FLT3 rearrangement, six with t(12;13)/ETV6-FLT3; one with ins(13;22)/BCR-FLT3; and five with an unconfirmed partner gene located on chromosome bands 2p16, 3q27, 5q15, 5q35, and 7q36. Disease presentations were heterogeneous, including lymphoblastic leukemia/lymphoma, myeloid sarcoma, chronic eosinophilic leukemia, chronic myelomonocytic leukemia, and myelodysplastic syndrome. However, some common features were observed, such as extramedullary involvement (n = 7, 58%), associated eosinophilia in blood, bone marrow, or tissue (n = 8, 67%), multilineage involvement, either as biphasic myeloid/lymphoid neoplasms (n = 2) or mixed phenotype acute leukemia (n = 2). Mutations were detected in 4/8 (50%) patients by next-generation sequencing. None (0/10) had FLT3 or KIT mutations. Eleven patients received disease-based chemotherapy or hypomethylating agents, three received FLT3 inhibitors, and five patients proceeded to hematopoietic stem cell transplant. Together with a review of 16 cases published in the literature, it is apparent that M/LNs with FLT3 rearrangement show disease features reminiscent of members in the category of M/LN-eo with PDGFRA, PDGFRB, FGFR1, and PCM1/JAK2 rearrangement, characterized by a specific gene rearrangement, frequent eosinophilia, multi-lineage involvement and therapeutic benefit from kinase inhibitors.
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Affiliation(s)
- Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prithviraj Bose
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Stephanie N Hurwitz
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Andres E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Kathryn Foucar
- Department of Pathology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Sangiorgio VFI, Arber DA. Non-hematopoietic neoplastic and pseudoneoplastic lesions of the spleen. Semin Diagn Pathol 2021; 38:159-164. [DOI: 10.1053/j.semdp.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
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Abstract
Objectives Acute myeloid leukemia (AML) with myelodysplasia-related changes (AML-MRC) represents a high-risk and somewhat diverse subtype of AML, and substantial confusion exists about the pathologic evaluation needed for diagnosis, which can include the patient’s clinical history, cytogenetic analysis, mutational analysis, and/or morphologic evaluation. Treatment decisions based on incomplete or untimely pathology reports may result in the suboptimal treatment of patients with AML-MRC. Methods Using a PubMed search, diagnosis of and treatment options for AML-MRC were investigated. Results This article reviews the current diagnostic criteria for AML-MRC, provides guidance on assessments necessary for an AML-MRC diagnosis, summarizes clinical and prognostic features of AML-MRC, and discusses potential therapies for patients with AML-MRC. In addition to conventional chemotherapy, treatment options include CPX-351, a liposomal encapsulation of daunorubicin/cytarabine approved for treatment of adults with AML-MRC; targeted agents for patients with certain mutations/disease characteristics; and lower-intensity therapies for less fit patients. Conclusions Given the evolving and complex treatment landscape and the high-risk nature of the AML-MRC population, a clear understanding of the pathology information necessary for AML-MRC diagnosis has become increasingly important to help guide treatment decisions and thereby improve patient outcomes.
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Affiliation(s)
- Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL
| | - Harry P Erba
- Department of Medicine, Duke University School of Medicine, Durham, NC
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35
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Boyiadzis MM, Aksentijevich I, Arber DA, Barrett J, Brentjens RJ, Brufsky J, Cortes J, De Lima M, Forman SJ, Fuchs EJ, Fukas LJ, Gore SD, Litzow MR, Miller JS, Pagel JM, Waller EK, Tallman MS. The Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of acute leukemia. J Immunother Cancer 2020; 8:jitc-2020-000810. [PMID: 33077513 PMCID: PMC7574947 DOI: 10.1136/jitc-2020-000810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
Acute leukemia is a constellation of rapidly progressing diseases that affect a wide range of patients regardless of age or gender. Traditional treatment options for patients with acute leukemia include chemotherapy and hematopoietic cell transplantation. The advent of cancer immunotherapy has had a significant impact on acute leukemia treatment. Novel immunotherapeutic agents including antibody-drug conjugates, bispecific T cell engagers, and chimeric antigen receptor T cell therapies have efficacy and have recently been approved by the US Food and Drug Administration (FDA) for the treatment of patients with acute leukemia. The Society for Immunotherapy of Cancer (SITC) convened a panel of experts to develop a clinical practice guideline composed of consensus recommendations on immunotherapy for the treatment of acute lymphoblastic leukemia and acute myeloid leukemia.
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Affiliation(s)
- Michael M Boyiadzis
- Department of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - John Barrett
- Stem Cell Allotransplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Renier J Brentjens
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jill Brufsky
- Department of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jorge Cortes
- Department of Medicine, Division of Hematology/Oncology, Georgia Cancer Center, Augusta, Georgia, USA
| | - Marcos De Lima
- Division of Hematology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen J Forman
- Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Linda J Fukas
- Clinical Research Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Steven D Gore
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey S Miller
- Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Orazi A, Arber DA. Pathology of the spleen: INTRODUCTION. Semin Diagn Pathol 2020; 38:111. [PMID: 32854986 DOI: 10.1053/j.semdp.2020.08.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Attilio Orazi
- Departments of Pathology, Texas Tech University Health Sciences Center, PL Foster School of Medicine, El Paso, TX, USA.
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
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37
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Foucar K, Hsi ED, Wang SA, Rogers HJ, Hasserjian RP, Bagg A, George TI, Bassett RL, Peterson LC, Morice WG, Arber DA, Orazi A, Bueso-Ramos CE. Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study. Int J Lab Hematol 2020; 42:418-422. [PMID: 32297416 DOI: 10.1111/ijlh.13212] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/06/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
Enumeration of blasts and promonocytes is essential for World Health Organization (WHO) classification of myelomonocytic neoplasms. The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to assess concordances between experienced hematopathologists in classifying cells as blasts, promonocytes, and monocytes according to WHO criteria. Each of 11 hematopathologists assessed glass slides from 20 patients [12 with chronic myelomonocytic leukemia (CMML) and 8 with acute myeloid leukemia (AML)] including blood and BM aspirate smears, and limited nonspecific esterase (NSE) stains. All cases were blindly reviewed. Fleiss' extension of Cohen's kappa for multiple raters was used on these variables, separately for peripheral blood (PB) and bone marrow (BM). Spearman's rank correlation was used to assess correlations between each pair of hematopathologists for each measurement. For the classification based on the sum of blasts and promonocytes in the BM, Fleiss' kappa was estimated as 0.744. For PB, categorizing patients according to the sum of blasts and promonocytes, Fleiss' kappa was estimated as 0.949. Distinction of abnormal monocytes from normal monocytes in PB did not achieve a good concordance and showed strong evidence of differences between hematopathologists (P < .0001). The hematopathologists achieved a good concordance rate of 74% in CMML vs AML classification and a high k rate, confirming that criteria for defining the blasts equivalents (blasts plus promonocytes) could be applied consistently. Identification of monocyte subtypes (abnormal vs normal) was not concordant. Our results support the practice of combining blasts/promonocytes into a single category.
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Affiliation(s)
- Kathryn Foucar
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sa A Wang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tracy I George
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Roland L Bassett
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - LoAnn C Peterson
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - William G Morice
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Attilio Orazi
- Department of Pathology, Texas Tech University, El Paso, Texas
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Zamò A, Johnston P, Attygalle AD, Laurent C, Arber DA, Fend F. Aggressive B-cell lymphomas with a primary bone marrow presentation. Histopathology 2020; 77:369-379. [PMID: 32324290 DOI: 10.1111/his.14124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/29/2020] [Revised: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
Aggressive B-cell lymphomas present as a heterogeneous spectrum of disease. A primary diagnosis in the bone marrow (BM) may be challenging in terms of diagnostic classification and clinical handling, owing to limited architectural information. Aggressive B-cell lymphomas can be subdivided into entities that typically present primarily in the BM, and cases with BM involvement in which the bulk of disease is present in other organs. One main topic at the 2018 BM workshop of the European Association of Haematopathology/Society of Hematopathology was therefore aggressive B-cell lymphomas with a primary BM presentation. The spectrum of cases submitted to this topic gave a good overview of commonly encountered problems, as well as unusual manifestations, and highlighted areas of imprecise disease definitions and diagnostic grey zones. The categories submitted to the workshop included cases of Burkitt lymphoma (BL) with unusual features, high-grade B-cell lymphomas (HG-BCLs) with and without so-called double/triple-hit, and diffuse large B-cell lymphomas (DLBCLs) with a primary BM presentation. Areas of difficulties included the morphological boundaries of HG-BCL not otherwise specified, cases with MYC and bcl-2 or bcl-6 translocations and terminal deoxynucleotidyl transferase (TdT) expression, which were categorised as B-cell lymphoblastic leukaemia/lymphoma if most cells showed TdT positivity, and the clinicopathological overlap between intravascular large B-cell lymphoma, CD5-positive DLBCL, and DLBCL with primary presentations in the BM, spleen, and liver. This review summarises our understanding of the main aggressive B-cell lymphoma categories with a common primary BM presentation and potential problem areas, and makes suggestions for the immunophenotypic and genetic work-up, illustrated by the interesting and challenging cases submitted to the workshop.
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Affiliation(s)
- Alberto Zamò
- Department of Oncology, University of Turin, Turin, Italy.,Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Peter Johnston
- Department of Pathology, NHS Grampian, University of Aberdeen, NHS Education for Scotland, Aberdeen, Scotland
| | | | - Camille Laurent
- Pathology and Cytology Department, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre de Recherche en Cancerologie de Toulouse, Inserm, UMR1037 laboratoire d'excellence TOUCAN, Paul Sabatier University Toulouse III, Toulouse, France
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Falko Fend
- Institute of Pathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
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Sangiorgio VFI, Arber DA. Vascular neoplasms and non-neoplastic vascular lesions of the spleen. Semin Diagn Pathol 2020; 38:154-158. [PMID: 32674844 DOI: 10.1053/j.semdp.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
Vascular neoplasms are among the most common conditions affecting the spleen. The majority of these are idiopathic, benign in nature and asymptomatic and therefore treated with a conservative management. Only rare cases cause splenomegaly and/or chronic consumption coagulopathies, thus requiring splenectomy. Among these, the most common is splenic hemangioma, followed by littoral cell angioma and lymphangioma. Peliosis is a peculiar tumor-like non-neoplastic vascular lesion that diffusely affects the spleen and frequently presents with concomitant hepatic involvement. As a distinctive feature, peliosis can occur as a secondary manifestation of infections, malignancies and in individuals using certain drugs. On the opposite spectrum of clinical behavior lies splenic angiosarcoma, a vascular endothelial malignancy with aggressive presentation and poor prognosis. In some cases the endothelial nature of this neoplasm may not be evident on routine histologic examination and immunohistochemistry is used to disclose such phenotype. The term hemangioendothelioma is rarely used to describe borderline vascular neoplasms which appear more aggressive than conventional hemangiomas, but that do not entirely fulfill the diagnostic criteria for angiosarcoma. Some of these neoplasms coexpress endothelial and histiocytic markers and therefore have been proposed as the borderline counterpart of littoral cell angioma. The existence of hemangioendothelioma as a diagnostic entity per se is debated and this diagnosis should be rendered with caution. The current review aims at highlighting the main histologic features of vascular neoplasms and non-neoplastic vascular lesions of the spleen.
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Affiliation(s)
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA.
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40
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Rogers HJ, Wang X, Xie Y, Davis AR, Thakral B, Wang SA, Borthakur G, Cantu MD, Margolskee EM, Philip JKS, Sukhanova M, Bagg A, Bueso‐Ramos CE, Orazi A, Arber DA, Hsi ED, Hasserjian RP. Comparison of therapy-related and de novo core binding factor acute myeloid leukemia: A bone marrow pathology group study. Am J Hematol 2020; 95:799-808. [PMID: 32249963 DOI: 10.1002/ajh.25814] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 01/20/2023]
Abstract
This multi-institutional study retrospectively evaluated clinicopathologic and genetic characteristics in 351 patients with core-binding-factor acute myeloid leukemia (CBF-AML), comprising 69 therapy-related (t-CBF-AML) and 282 de novo cases. The T-CBF-AML patients were older, had lower WBC counts, and slightly higher hemoglobin than patients with de novo disease. Secondary cytogenetic abnormalities were more frequent in patients with de novo disease than t-CBF-AML (57.1% vs 41.1%, P = .026). Patients with secondary cytogenetic abnormalities had longer overall survival (OS) than those without abnormalities (median 190 vs 87 months, P = .021); trisomy 8, trisomy 22, and loss of the X or Y chromosome were associated with longer OS. In the 165 cases performed of targeted gene sequencing, pathogenic mutations were detected in 75.7% of cases, and were more frequent in de novo than in therapy-related disease (P = .013). Mutations were found in N/KRAS (37.0%), FLT3 (27.8%), KIT (17.2%), TET2 (4.9%), and ASXL1 (3.9%). The TET2 mutations were associated with shorter OS (P = .012) while N/KRAS mutation was associated with longer OS in t(8;21) AML patients (P = .001). The KIT mutation did not show prognostic significance in this cohort. Although they received similar therapy, t-CBF-AML patients had shorter OS than de novo patients (median 69 vs 190 months, P = .038). In multivariate analysis of all patients, older age and absence of any secondary cytogenetic abnormalities were significant predictors of shorter OS. Among the t-CBF-AML subset, age and hemoglobin were significant on multivariate analysis. This study demonstrated that although de novo and t-CBF-AML patients share many features, t-CBF-AML patients have worse clinical outcome than de novo patients.
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Affiliation(s)
- Heesun J. Rogers
- Department of Laboratory MedicineCleveland Clinic Cleveland Ohio USA
| | - Xiaoqiong Wang
- Department of Laboratory MedicineCleveland Clinic Cleveland Ohio USA
| | - Yan Xie
- Department of Laboratory MedicineCleveland Clinic Cleveland Ohio USA
| | - Adam R. Davis
- Department of Pathology and Laboratory MedicineUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Beenu Thakral
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sa A. Wang
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Miguel D. Cantu
- Department of Pathology, Weill Cornell Medicine New York New York USA
| | | | | | - Madina Sukhanova
- Department of PathologyNorthwestern University Chicago Illinois USA
| | - Adam Bagg
- Department of Pathology and Laboratory MedicineUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Carlos E. Bueso‐Ramos
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Attilio Orazi
- Department of PathologyTexas Tech University Health Science Center El Paso Texas USA
| | - Daniel A. Arber
- Department of PathologyUniversity of Chicago Chicago Illinois USA
| | - Eric D. Hsi
- Department of Laboratory MedicineCleveland Clinic Cleveland Ohio USA
| | - Robert P. Hasserjian
- Department of Pathology, Massachusetts General Hospital Boston Massachusetts USA
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Attygalle AD, Zamò A, Fend F, Johnston P, Arber DA, Laurent C. Challenges and limitations in the primary diagnosis of T-cell and natural killer cell/T-cell lymphoma in bone marrow biopsy. Histopathology 2020; 77:2-17. [PMID: 32064659 DOI: 10.1111/his.14093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | - Alberto Zamò
- Department of Oncology, University of Turin, Turin, Italy.,Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Falko Fend
- Institute of Pathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
| | - Peter Johnston
- Department of Pathology, NHS Grampian, University of Aberdeen, NHS Education for Scotland, Aberdeen, UK
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Camille Laurent
- Pathology and Cytology Department, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre de Recherche en Cancerologie de Toulouse, Inserm, UMR1037 laboratoire d'excellence TOUCAN, Paul Sabatier University Toulouse III, Toulouse, France
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Laurent C, Arber DA, Johnston P, Fend F, Zamo A, Attygalle AD. Diagnosis of classic Hodgkin lymphoma on bone marrow biopsy. Histopathology 2020; 76:934-941. [PMID: 32092168 DOI: 10.1111/his.14085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Camille Laurent
- Pathology and Cytology Department, Centre Hospitalo-Universitaire de Toulouse, Toulouse III, Toulouse, France
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Peter Johnston
- Department of Pathology, NHS Grampian, University of Aberdeen, NHS Education for Scotland, Edinburgh, UK
| | - Falko Fend
- Institute of Pathology and Comprehensive Cancer Center, Tübingen University Hospital, Tübingen, Germany
| | - Alberto Zamo
- Department of Oncology, University of Turin, Italy and Institute of Pathology, University of Würzburg, Würzburg, Germany
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Sangiorgio VFI, Orazi A, Arber DA. Myelodysplastic/myeloproliferative neoplasms: are morphology and immunophenotyping still relevant? Best Pract Res Clin Haematol 2019; 33:101139. [PMID: 32460987 DOI: 10.1016/j.beha.2019.101139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 01/16/2023]
Abstract
The term myelodysplastic/myeloproliferative neoplasm (MDS/MPN) refers to a group of clonal hematopoietic neoplasms with overlapping clinical, morphologic and genetic myelodysplastic and myeloproliferative features observed at the time of first presentation. Impaired hematopoiesis morphologically associated with evidence of myelodysplasia manifests clinically with cytopenia/s. Simultaneously, myeloproliferation is seen within the bone marrow and leads to cytosis in the peripheral blood. The diagnostic category of MDS/MPN encompasses a heterogeneous group of diseases which share similarities among them, but at the same time have distinct clinical and pathologic features and eventually diverse prognosis; such differences justify their separation in a classification scheme. In the era of genetic and genomic tests, their distinction from conventional myelodysplastic syndromes or myeloproliferative neoplasms still relies on close clinocopathological correlation, with evaluation of both peripheral blood and bone marrow samples being essential in this sense. A multiparametric integration of clinicopathologic data and cytogenetics and molecular genetics results is the preferred diagnostic approach.
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Affiliation(s)
- V F I Sangiorgio
- Department of Cellular Pathology, The Royal London Hospital, London, UK
| | - A Orazi
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - D A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA.
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Sangiorgio VFI, Arber DA, Orazi A. How I investigate chronic myelomonocytic leukemia. Int J Lab Hematol 2019; 42:101-108. [PMID: 31841277 DOI: 10.1111/ijlh.13145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/18/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
The 2016 revised 4th edition of the World Health Organization classification of hematopoietic neoplasms updated the diagnostic criteria for chronic myelomonocytic leukemia (CMML). Persistent peripheral blood monocytosis of at least 1 × 109 /L and a percentage of monocytes ≥10% of the circulating white blood cell count (WBC) are both prerequisite criteria for this diagnosis. CMML represents the prototype of "overlapping" myeloid neoplasms with concurrent myeloproliferative and myelodysplastic features. However, clinical presentation is heterogeneous, with cases showing prevailing "dysplastic" features and others a predominant "proliferative" phenotype. Accounting for this diversity, two variants of CMML are recognized: "dysplastic" CMML defined by WBC < 13 × 109 /L and "proliferative" CMML with WBC ≥ 13 × 109 /L often showing features mimicking a myeloproliferative neoplasm. Although not an official WHO category, the "oligomonocytic" variant of CMML is defined by relative monocytosis with an absolute monocyte count of 0.5-0.9 × 109 /L. It can be considered a "pre-phase," as it frequently anticipates the development of an overt, classic CMML. In an attempt at improving disease prognostication, the blast count based grading system for CMML of the WHO 2008 Classification has been expanded in 2016 to include a new "CMML-0" category. Lastly, the large body of knowledge on the molecular events occurring in CMML has been used to assist diagnosis and assess prognosis. Despite the step forwards, diagnosis of CMML still remains one of exclusion as no clinical, pathologic or molecular findings are specific for this disease. The current review brings insight into the spectrum of CMML and provides practical advice to approach suspected cases of CMML.
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Affiliation(s)
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Attilio Orazi
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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45
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Weinberg OK, Hasserjian RP, Baraban E, Ok CY, Geyer JT, Philip JKSS, Kurzer JH, Rogers HJ, Nardi V, Stone RM, Garcia JS, Hsi ED, Bagg A, Wang SA, Orazi A, Arber DA. Clinical, immunophenotypic, and genomic findings of acute undifferentiated leukemia and comparison to acute myeloid leukemia with minimal differentiation: a study from the bone marrow pathology group. Mod Pathol 2019; 32:1373-1385. [PMID: 31000771 DOI: 10.1038/s41379-019-0263-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 01/11/2023]
Abstract
Acute undifferentiated leukemia is a rare type of acute leukemia that shows no evidence of differentiation along any lineage. Clinical, immunophenotypic and genetic data is limited and it is uncertain if acute undifferentiated leukemia is biologically distinct from acute myeloid leukemia with minimal differentiation, which also shows limited myeloid marker expression and has been reported to have a poor prognosis. We identified 92 cases initially diagnosed as acute undifferentiated leukemia or acute myeloid leukemia with minimal differentiation from pathology databases of nine academic institutions with available diagnostic flow cytometric data, cytogenetic findings, mutational and clinical data. Outcome analysis was performed using Kaplan Meier test for the 53 patients who received induction chemotherapy. Based on cytogenetic abnormalities (N = 30) or history of myelodysplastic syndrome (N = 2), 32 cases were re-classified as acute myeloid leukemia with myelodysplasia related changes. The remaining 24 acute undifferentiated leukemia patients presented with similar age, blood counts, bone marrow cellularity, and blast percentage as the remaining 30 acute myeloid leukemia with minimal differentiation patients. Compared to acute myeloid leukemia with minimal differentiation, acute undifferentiated leukemia cases were characterized by more frequent mutations in PHF6 (5/15 vs 0/19, p = 0.016) and more frequent expression of TdT on blasts (p = 0.003) while acute myeloid leukemia with minimal differentiation cases had more frequent CD123 expression (p = 0.042). Outcome data showed no difference in overall survival, relapse free survival, or rates of complete remission between acute undifferentiated leukemia and acute myeloid leukemia with minimal differentiation groups (p > 0.05). Acute myeloid leukemia with myelodysplasia-related changes patients showed shorter survival when censoring for bone marrow transplant as compared to acute undifferentiated leukemia (p = 0.03) and acute myeloid leukemia with minimal differentiation (p = 0.002). In this largest series to date, the acute undifferentiated leukemia group shows distinct characteristics from acute myeloid leukemia with minimal differentiation, including more frequent PHF6 mutations and expression of TdT.
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Affiliation(s)
- Olga K Weinberg
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA.
| | | | - Ezra Baraban
- Department of Pathology and Laboratory Medicine, the University of Pennsylvania, Philadelphia, PA, USA
| | - Chi Young Ok
- Departments of Hematopathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Julia T Geyer
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - John K S S Philip
- Department of Pathology and Laboratory Medicine, University of Chicago, Chicago, IL, USA
| | - Jason H Kurzer
- Department of Pathology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jacqueline S Garcia
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, the University of Pennsylvania, Philadelphia, PA, USA
| | - Sa A Wang
- Departments of Hematopathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Attilio Orazi
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - Daniel A Arber
- Department of Pathology and Laboratory Medicine, University of Chicago, Chicago, IL, USA
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Abstract
OBJECTIVES The 2017 Workshop of the Society for Hematopathology/European Association for Haematopathology examined the role of molecular genetics in the diagnosis and biology of acute leukemia. METHODS Acute leukemias were reviewed in two sessions: "Genetic Testing in Diagnosis of Acute Leukemias" (53 cases) and "Genetics Revealing the Biology of Acute Leukemias" (41 cases). RESULTS Cases included acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemia of ambiguous lineage. Many cases demonstrated genetic alterations of known diagnostic, prognostic, and/or therapeutic significance, while others exhibited alterations that illuminated disease biology. The workshop highlighted the complexity of acute leukemia diagnosis and follow-up, while illustrating advantages and pitfalls of molecular genetic testing. CONCLUSIONS Our understanding of the molecular genetics of acute leukemias continues to grow rapidly. Awareness of the potential complexity of genetic architecture and environment is critical and emphasizes the importance of integrating clinical information with morphologic, immunophenotypic, and molecular genetic evaluation.
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Affiliation(s)
- Marian H Harris
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| | - David R Czuchlewski
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL
| | - Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis
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Arber DA, Orazi A. Update on the pathologic diagnosis of chronic myelomonocytic leukemia. Mod Pathol 2019; 32:732-740. [PMID: 30723295 DOI: 10.1038/s41379-019-0215-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 12/15/2022]
Abstract
The diagnostic criteria for chronic myelomonocytic leukemia were recently revised in the 2016 World Health Organization classification update and include new and revised subtypes. In addition, molecular genetic studies have provided new insights into the prognosis and diagnosis of this myeloid neoplasm. This review summarizes the 2016 changes to the diagnostic criteria, discusses potential future changes that may impact diagnosis and provides an overview of recent advances in the diagnosis and prognosis determination of chronic myelomonocytic leukemia.
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Affiliation(s)
- Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA.
| | - Attilio Orazi
- Department of Pathology, Texas Tech Health Sciences Center, El Paso, TX, USA
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48
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Valent P, Orazi A, Savona MR, Patnaik MM, Onida F, van de Loosdrecht AA, Haase D, Haferlach T, Elena C, Pleyer L, Kern W, Pemovska T, Vladimer GI, Schanz J, Keller A, Lübbert M, Lion T, Sotlar K, Reiter A, De Witte T, Pfeilstöcker M, Geissler K, Padron E, Deininger M, Orfao A, Horny HP, Greenberg PL, Arber DA, Malcovati L, Bennett JM. Proposed diagnostic criteria for classical chronic myelomonocytic leukemia (CMML), CMML variants and pre-CMML conditions. Haematologica 2019; 104:1935-1949. [PMID: 31048353 PMCID: PMC6886439 DOI: 10.3324/haematol.2019.222059] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a myeloid neoplasm characterized by dysplasia, abnormal production and accumulation of monocytic cells and an elevated risk of transforming into acute leukemia. Over the past two decades, our knowledge about the pathogenesis and molecular mechanisms in CMML has increased substantially. In parallel, better diagnostic criteria and therapeutic strategies have been developed. However, many questions remain regarding prognostication and optimal therapy. In addition, there is a need to define potential pre-phases of CMML and special CMML variants, and to separate these entities from each other and from conditions mimicking CMML. To address these unmet needs, an international consensus group met in a Working Conference in August 2018 and discussed open questions and issues around CMML, its variants, and pre-CMML conditions. The outcomes of this meeting are summarized herein and include diag nostic criteria and a proposed classification of pre-CMML conditions as well as refined minimal diagnostic criteria for classical CMML and special CMML variants, including oligomonocytic CMML and CMML associated with systemic mastocytosis. Moreover, we propose diagnostic standards and tools to distinguish between 'normal', pre-CMML and CMML entities. These criteria and standards should facilitate diagnostic and prognostic evaluations in daily practice and clinical studies in applied hematology.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria .,Ludwig Boltzmann Institute for Hematology & Oncology, Vienna, Austria
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Michael R Savona
- Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francesco Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, the Netherlands
| | - Detlef Haase
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Chiara Elena
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Lisa Pleyer
- 3 Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria
| | | | - Tea Pemovska
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Gregory I Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Julie Schanz
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexandra Keller
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Michael Lübbert
- Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lion
- Children's Cancer Research Institute and Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theo De Witte
- Department of Tumor Immunology-Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael Pfeilstöcker
- Ludwig Boltzmann Institute for Hematology & Oncology, Vienna, Austria.,3 Medical Department, Hanusch Hospital, Vienna, Vienna, Austria
| | | | - Eric Padron
- Malignant Hematology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Michael Deininger
- Huntsman Cancer Institute & Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA
| | - Alberto Orfao
- Servicio Central de Citometría, Centro de Investigación del Cáncer (IBMCC, CSIC-USAL), CIBERONC and IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | | | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Luca Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - John M Bennett
- Department of Pathology, Hematopathology Unit and James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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49
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Tang G, Sydney Sir Philip JK, Weinberg O, Tam W, Sadigh S, Lake JI, Margolskee EM, Rogers HJ, Miranda RN, Bueso-Ramos C C, Hsi ED, Orazi A, Hasserjian RP, Arber DA, Bagg A, Wang SA. Hematopoietic neoplasms with 9p24/JAK2 rearrangement: a multicenter study. Mod Pathol 2019; 32:490-498. [PMID: 30401948 DOI: 10.1038/s41379-018-0165-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/28/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022]
Abstract
The purpose of this study is to examine hematopoietic neoplasms with 9p24/JAK2 rearrangement including neoplasms associated with t(8;9)(p22;p24)/PCM1-JAK2 fusion neoplasm as well as cases with translocations involving 9p24/JAK2 and other partner genes. From seven large medical centers, we identified ten patients with t(8;9)(p22;p24) /PCM1-JAK2 and 3 with t(9p24;v)/JAK2 at diagnosis. Majority of the cases showed myeloproliferative neoplasm (MPN) associated features (n = 7) characterized by variable degrees of eosinophilia, myelofibrosis, frequent proliferations of early erythroblasts in bone marrow and extramedullary sites, and infrequent/absent somatic mutations. Other less common presentations included myelodysplastic syndromes (MDS) or MDS/MPN (one each). Four patients presented with B-lymphoblastic leukemia (B-ALL), and of them, two patients with t(8;9)(p22;p24.1) were proven to be B-lymphoblastic crisis of MPN; and the other two cases with t(9p24;v) both were de novo B-ALL, BCR-ABL1-like (Ph-like). We show that the hematopoietic neoplasms with 9p24/JAK2 rearrangement are extremely rare, and most of them are associated with t(8;9)(p22;p24)/PCM1-JAK2, a recent provisional World Health Organization entity under "myeloid/lymphoid neoplasm with a specific gene rearrangement". Cases of t(8;9)(p22;p24)/PCM1-JAK2, though heterogeneous, do exhibit some common clinicopathological characteristic features. Cases with t(9p24;v)/JAK2 are extremely rare; while such cases with a MPN presentation may resemble t(8;9)(p22;p24.1)/PCM1-JAK2, B-ALL cases presenting de novo B-ALL might belong to Ph-like B-ALL.
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Affiliation(s)
- Guilin Tang
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Olga Weinberg
- Department of Pathology, Boston Children Hospital, Boston, MA, USA
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sam Sadigh
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan I Lake
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Margolskee
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Carlos Bueso-Ramos C
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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50
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de Haas V, Ismaila N, Advani A, Arber DA, Dabney RS, Patel-Donelly D, Kitlas E, Pieters R, Pui CH, Sweet K, Zhang L. Initial Diagnostic Work-Up of Acute Leukemia: ASCO Clinical Practice Guideline Endorsement of the College of American Pathologists and American Society of Hematology Guideline. J Clin Oncol 2019; 37:239-253. [PMID: 30523709 PMCID: PMC6338392 DOI: 10.1200/jco.18.01468] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Accepted: 09/24/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The College of American Pathologists (CAP) and the American Society of Hematology (ASH) developed an evidence-based guideline on the initial diagnostic work-up of acute leukemia (AL). Because of the relevance of this topic to the ASCO membership, ASCO reviewed the guideline and applied a set of procedures and policies for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS The CAP-ASH guideline on initial diagnostic work-up of AL was reviewed for developmental rigor by methodologists. Then, an ASCO Endorsement Expert Panel updated the literature search and reviewed the content and recommendations. RESULTS The ASCO Expert Panel determined that the recommendations from the guideline, published in 2016, are clear, thorough, and based on the most relevant scientific evidence. ASCO fully endorsed the CAP-ASH guideline on initial diagnostic work-up of AL and included some discussion points according to clinical practice and updated literature. CONCLUSION Twenty-seven guideline statements were reviewed. Some discussion points were included to better assess CNS involvement in leukemia and to provide novel insights into molecular diagnosis and potential markers for risk stratification and target therapy. These discussions are categorized into four sections: (1) initial diagnosis focusing on basic diagnostics and determination of risk parameters, (2) molecular markers and minimal residual disease detection, (3) context of referral to another institution with expertise in the management of AL, and (4) reporting and record keeping for better outlining and follow-up discussion. Additional information is available at: www.asco.org/hematologic-malignancies-guidelines .
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Affiliation(s)
- Valérie de Haas
- 1 Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | | | | | | | - Rob Pieters
- 1 Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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