1
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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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2
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Tefferi A, Pardanani A, Begna KH, Al-Kali A, Hogan WJ, Litzow MR, Ketterling RP, Reichard KK, Gangat N. Calr type 1/like mutation in myelofibrosis is the most prominent predictor of momelotinib drug survival and longevity without transplant. Blood Cancer J 2024; 14:51. [PMID: 38503764 PMCID: PMC10951334 DOI: 10.1038/s41408-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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3
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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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4
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Begna KH, Abdallah NH, Janania-Martinez M, Mangaonkar AA, Rangan A, Herrick JL, Gangat N. Daratumumab and brentuximab vedotin combination therapy in T-cell acute lymphoblastic leukemia refractory to conventional chemotherapy and allogeneic stem cell transplant. Haematologica 2024; 109:689-692. [PMID: 37706335 PMCID: PMC10828762 DOI: 10.3324/haematol.2023.283740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Kebede H Begna
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester.
| | - Nadine H Abdallah
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester
| | | | | | - Aruna Rangan
- Department of Laboratory medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester
| | - Jennifer L Herrick
- Department of Laboratory medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester
| | - Naseema Gangat
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester
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5
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Gangat N, Karrar O, Iftikhar M, McCullough K, Johnson IM, Abdelmagid M, Abdallah M, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Saliba AN, Hefazi Torghabeh M, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Badar T, Murthy H, Foran J, Palmer J, Sproat L, Khera N, Arana Yi C, Tefferi A. Venetoclax and hypomethylating agent combination therapy in newly diagnosed acute myeloid leukemia: Genotype signatures for response and survival among 301 consecutive patients. Am J Hematol 2024; 99:193-202. [PMID: 38071734 DOI: 10.1002/ajh.27138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 01/21/2024]
Abstract
Venetoclax + hypomethylating agent (Ven-HMA) is currently the standard frontline therapy for older/unfit patients with newly diagnosed acute myeloid leukemia (ND-AML). Our objective in the current retrospective study of 301 adult patients (median age 73 years; 62% de novo) with ND-AML was to identify molecular predictors of treatment response to Ven-HMA and survival; European LeukemiaNet (ELN) genetic risk assignment was favorable 15%, intermediate 16%, and adverse 69%. Complete remission, with (CR) or without (CRi), count recovery, was documented in 182 (60%) patients. In multivariable analysis, inclusive of mutations only, "favorable" predictors of CR/CRi were NPM1 (86% vs. 56%), IDH2 (80% vs. 58%), and DDX41 (100% vs. 58%) and "unfavorable" TP53 (40% vs. 67%), FLT3-ITD (36% vs. 63%), and RUNX1 (44% vs. 64%) mutations; significance was sustained for each mutation after adjustment for age, karyotype, and therapy-related qualification. CR/CRi rates ranged from 36%, in the presence of unfavorable and absence of favorable mutation, to 91%, in the presence of favorable and absence of unfavorable mutation. At median follow-up of 8.5 months, 174 deaths and 41 allogeneic stem cell transplants (ASCT) were recorded. In multivariable analysis, risk factors for inferior survival included failure to achieve CR/CRi (HR 3.4, 95% CI 2.5-4.8), adverse karyotype (1.6, 1.1-2.6), TP53 mutation (1.6, 1.0-2.4), and absence of IDH2 mutation (2.2, 1.0-4.7); these risk factors were subsequently applied to construct an HR-weighted risk model that performed better than the ELN genetic risk model (AIC 1661 vs. 1750): low (n = 130; median survival 28.9 months), intermediate (n = 105; median 9.6 months), and high (n = 66; median 3.1 months; p < .001); survival in each risk category was significantly upgraded by ASCT. The current study identifies genotype signatures for predicting response and proposes a 3-tiered, CR/CRi-based, and genetics-enhanced survival model for AML patients receiving upfront therapy with Ven-HMA.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Isla M Johnson
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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6
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Shah NP, Bhatia R, Altman JK, Amaya M, Begna KH, Berman E, Chan O, Clements J, Collins RH, Curtin PT, DeAngelo DJ, Drazer M, Maness L, Metheny L, Mohan S, Moore JO, Oehler V, Pratz K, Pusic I, Rose MG, Shomali W, Smith BD, Styler M, Talpaz M, Tanaka TN, Tantravahi S, Thompson J, Tsai S, Vaughn J, Welborn J, Yang DT, Sundar H, Gregory K. Chronic Myeloid Leukemia, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2024; 22:43-69. [PMID: 38394770 DOI: 10.6004/jnccn.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome resulting from a reciprocal translocation between chromosomes 9 and 22 [t9;22] that gives rise to a BCR::ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase in developed countries. Tyrosine kinase inhibitor (TKI) therapy is a highly effective treatment option for patients with chronic phase-CML. The primary goal of TKI therapy in patients with chronic phase-CML is to prevent disease progression to accelerated phase-CML or blast phase-CML. Discontinuation of TKI therapy with careful monitoring is feasible in selected patients. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with chronic phase-CML.
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MESH Headings
- Humans
- Blast Crisis/chemically induced
- Blast Crisis/drug therapy
- Blast Crisis/genetics
- Protein Kinase Inhibitors/adverse effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Philadelphia Chromosome
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Fusion Proteins, bcr-abl/genetics
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Affiliation(s)
- Neil P Shah
- 1UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Jessica K Altman
- 3Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Leland Metheny
- 14Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Keith Pratz
- 18Abramson Cancer Center at the University of Pennsylvania
| | - Iskra Pusic
- 19Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - B Douglas Smith
- 22The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | - Jennifer Vaughn
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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7
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Karrar O, Abdelmagid M, Rana M, Iftikhar M, McCullough K, Al-Kali A, Alkhateeb HB, Begna KH, Elliott MA, Mangaonkar A, Saliba A, Hefazi Torghabeh M, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Badar T, Murthy H, Foran J, Palmer J, Sproat L, Khera N, Arana Yi C, Tefferi A, Gangat N. Venetoclax duration (14 vs. 21 vs. 28 days) in combination with hypomethylating agent in newly diagnosed acute myeloid leukemia: Comparative analysis of response, toxicity, and survival. Am J Hematol 2024; 99:E63-E66. [PMID: 38100217 DOI: 10.1002/ajh.27180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
Overall survival and response rates of 270 patients with newly diagnosed acute myeloid leukemia receiving venetoclax (Ven) plus hypomethylating agent, stratified by Ven dosing schedule (Cycle 1 Ven 14 vs. 21 vs. 28 days).
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Affiliation(s)
- Omer Karrar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maymona Abdelmagid
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Masooma Rana
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen McCullough
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Antoine Saliba
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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8
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Gangat N, Karrar O, Al-Kali A, Begna KH, Elliott MA, Wolanskyj-Spinner AP, Pardanani A, Hanson CA, Ketterling RP, Tefferi A. One thousand patients with essential thrombocythemia: the Mayo Clinic experience. Blood Cancer J 2024; 14:11. [PMID: 38238303 PMCID: PMC10796913 DOI: 10.1038/s41408-023-00972-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024] Open
Abstract
We describe 1000 patients with essential thrombocythemia seen at the Mayo Clinic between 1967 and 2023: median age 58 years (18-90), females 63%, JAK2/CALR/MPL-mutated 62%/27%/3%, triple-negative (TN) 8%, extreme thrombocytosis (ExT; platelets ≥1000 × 109/L) 26%, leukocytosis (leukocyte count >11 × 109/L) 20%, and abnormal karyotype 6%. JAK2-mutated patients were older (median 71 years), and CALR mutated (52 years), and TN (50 years) younger (p < 0.01). Female gender clustered with TN (73%) and JAK2 (69%) vs. CALR/MPL (49%/47%) mutations (p < 0.01). ExT clustered with CALR (type-2 more than type-1) and TN and leukocytosis with JAK2 mutation (p < 0.01). In multivariable analysis, risk factors for overall survival were older age (p < 0.01), male gender (HR 1.8), absolute neutrophil count (ANC) ≥ 8 × 109/L (HR 1.6), absolute lymphocyte count (ALC) < 1.7 × 109/L (HR 1.5), hypertension (HR 1.7), and arterial thrombosis history (HR 1.7); for leukemia-free survival, ExT (HR 2.3) and abnormal karyotype (HR 3.1); for myelofibrosis-free survival, ANC ≥ 8 × 109/L (HR 2.3) and MPL mutation (HR 3.9); for arterial thrombosis-free survival, age ≥60 years (HR 1.9), male gender (HR 1.6), arterial thrombosis history (HR 1.7), hypertension (HR 1.7), and JAK2 mutation (HR 1.8); for venous thrombosis-free survival, male gender (HR 1.8) and venous thrombosis history (HR 3.0). Associations between ExT and leukemic transformation and between ANC and fibrotic progression were limited to JAK2-mutated cases. Aspirin therapy appeared to mitigate both arterial (HR 0.4) and venous (HR 0.4) thrombosis risk. HR-based risk models delineated patients with median survivals ranging from 10 years to not reached and 20-year leukemia/myelofibrosis incidences from 3%/21% to 12.8%/49%. The current study provides both novel and confirmatory observations of essential thrombocythemia.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Curtis A Hanson
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P Ketterling
- Division of Laboratory Medicine and Cytogenetics, Mayo Clinic, Rochester, MN, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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9
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Gangat N, Ilyas R, Johnson IM, McCullough K, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Tefferi A. Outcome of patients with acute myeloid leukemia following failure of frontline venetoclax plus hypomethylating agent therapy. Haematologica 2023; 108:3170-3174. [PMID: 36861409 PMCID: PMC10620560 DOI: 10.3324/haematol.2022.282677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
| | - Rimal Ilyas
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
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10
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Abdelmagid MG, Al-Kali A, Begna KH, Hogan WJ, Litzow MR, Fleti F, Mangaonkar AA, Patnaik MS, Elliott MA, Alkhateeb H, Shi M, Howard MT, Reichard KK, Ketterling RP, Shah M, Pardanani A, Gangat N, Tefferi A. Blast phase myeloproliferative neoplasm with prior exposure to ruxolitinib: comparative analysis of mutations and survival. Haematologica 2023; 108:2542-2545. [PMID: 36794509 PMCID: PMC10483339 DOI: 10.3324/haematol.2022.282627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Min Shi
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Matthew T Howard
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Kaaren K Reichard
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Divisions of Hematopathology, Departments of Laboratory Medicine, Mayo Clinic, Rochester, MN
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11
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Abdelmagid MG, Al-Kali A, Litzow MR, Begna KH, Hogan WJ, Patnaik MS, Hashmi SK, Elliott MA, Alkhateeb H, Karrar OS, Fleti F, Elnayir MH, Rivera CE, Murthy HS, Foran JM, Kharfan-Dabaja MA, Badar T, Viswanatha DS, Reichard KK, Gangat N, Tefferi A. Real-world experience with ponatinib therapy in chronic phase chronic myeloid leukemia: impact of depth of response on survival and prior exposure to nilotinib on arterial occlusive events. Blood Cancer J 2023; 13:122. [PMID: 37567878 PMCID: PMC10421909 DOI: 10.1038/s41408-023-00891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
We surveyed the performance of ponatinib, as salvage therapy, in a real-world setting of chronic phase chronic myeloid leukemia (CML-CP). Among 55 consecutive patients (median age 49 years) with relapsed/refractory CML-CP, 35 (64%) had failed ≥3 tyrosine kinase inhibitors (TKIs), 35 (64%) were pre-treated with nilotinib, and 14 (28%) harbored ABL1T315I. At start of ponatinib (median dose 30 mg/day), 40 patients were already in complete hematologic (CHR), 4 in complete cytogenetic (CCyR), 3 in major molecular (MMR) remission, while 8 had not achieved CHR (NR). Ponatinib improved the depth of response in 13 (33%), 3 (75%), 2 (66%), and 4 (50%) patients with CHR, CCyR, MMR, and NR, respectively (p = 0.02). At a median follow-up of 42 months, 13 (23%) deaths, 5 (9%) blast transformations, and 25 (45%) allogeneic transplants were recorded. Five/10-year post-ponatinib survival was 77%/58% with no significant difference when patients were stratified by allogeneic transplant (p = 0.94), ponatinib-induced deeper response (p = 0.28), or a post-ponatinib ≥CCyR vs CHR remission state (p = 0.25). ABL1T315I was detrimental to survival (p = 0.04) but did not appear to affect response. Prior exposure to nilotinib was associated with higher risk of arterial occlusive events (AOEs; 11% vs 0%; age-adjusted p = 0.04). Ponatinib starting/maintenance dose (45 vs 15 mg/day) did not influence either treatment response or AOEs. Our observations support the use of a lower starting/maintenance dose for ponatinib in relapsed/refractory CML-CP but a survival advantage for deeper responses was not apparent and treatment might not overcome the detrimental impact of ABL1T315I on survival. The association between prior exposure to nilotinib and a higher risk of post-ponatinib AOEs requires further validation.
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Affiliation(s)
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | - Omer S Karrar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Farah Fleti
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | - David S Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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12
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Gangat N, Kuykendall A, Al Ali N, Goel S, Abdelmagid M, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Komrokji R, Tefferi A. Black African-American patients with primary myelofibrosis: a comparative analysis of phenotype and survival. Blood Adv 2023; 7:2694-2698. [PMID: 36780345 PMCID: PMC10333736 DOI: 10.1182/bloodadvances.2022009611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 02/14/2023] Open
Affiliation(s)
| | - Andrew Kuykendall
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Najla Al Ali
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Swati Goel
- Department of Oncology (Hematology), Montefiore Medical Center, Bronx, NY
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
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13
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Gurney M, Chekkaf I, Baranwal A, Basmaci R, Katamesh B, Greipp P, Foran JM, Badar T, Mangaonkar AA, Begna KH, Gangat N, Patnaik MM, Litzow MR, Shah MV, Viswanatha DS, He R, Alkhateeb HB, Al-Kali A. The clinical and molecular spectrum of ETV6 mutated myeloid neoplasms. Br J Haematol 2023. [PMID: 37144345 DOI: 10.1111/bjh.18850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
ETV6 mutations are rare but recurrent somatic events in myeloid neoplasms and are negatively prognostic in myelodysplastic syndrome. We set out to examine the clinical and molecular characteristics of patients undergoing investigation for myeloid neoplasms, found to have deleterious ETV6 mutations. ETV6 mutations occurred in 33 of 5793 (0.6%) cases investigated and predominantly in high-risk disease entities including MDS with increased blasts, primary myelofibrosis and AML, myelodysplasia-related. In three cases, isolated iso (17q) karyotype was concurrently detected, an otherwise rare karyotype in myeloid neoplasms. ETV6 mutations were frequently subclonal and never occurred as an isolated abnormality with ASXL1 (n = 22, 75%), SRSF2 (n = 14, 42%) and SETBP1 (n = 11, 33%) the predominant co-mutations. Restricting to patients with MDS, higher rates of ASXL1, SETBP1, RUNX1 and U2AF1 mutations occurred in ETV6 mutated cases, relative to a consecutive control cohort with wild-type ETV6. The median OS of the cohort was 17.5 months. This report highlights the clinical and molecular associations of somatic ETV6 mutations in myeloid neoplasms, suggests their occurrence as a later event, and proposes further translational research questions for their role in myeloid neoplasia.
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Affiliation(s)
- Mark Gurney
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anmol Baranwal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rami Basmaci
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bahga Katamesh
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia Greipp
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - James M Foran
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rong He
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Gangat N, Abdallah M, Szuber N, Saliba A, Alkhateeb H, Al-Kali A, Begna KH, Pardanani A, Tefferi A. Sodium-glucose co-transporter-2 inhibitor use and JAK2 unmutated erythrocytosis in 100 consecutive cases. Am J Hematol 2023. [PMID: 37073574 DOI: 10.1002/ajh.26933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mostafa Abdallah
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Natasha Szuber
- Department of Hematology, Université de Montréal, Montréal, Quebec, Canada
| | - Antoine Saliba
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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15
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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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16
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Abdallah M, McCullough K, Ilyas R, Begna KH, Al-Kali A, Litzow MR, Hogan WJ, Mangaonkar A, Alkhateeb H, Shah MV, Elliott MA, Foran JM, Badar T, Palmer JM, Yi CA, Sproat L, Pardanani A, Patnaik MM, Olteanu H, Ketterling RP, Tefferi A, Gangat N. Abnormal karyotype is an independent predictor of inferior survival in Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN). Blood Cancer J 2023; 13:35. [PMID: 36907917 PMCID: PMC10008821 DOI: 10.1038/s41408-023-00812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023] Open
Affiliation(s)
| | | | - Rimal Ilyas
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P Ketterling
- Division of Laboratory Medicine and Cytogenetics, Mayo Clinic, Rochester, MN, USA
| | | | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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17
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Gangat N, Begna KH, Al-Kali A, Hogan W, Litzow M, Pardanani A, Tefferi A. Predictors of anemia response to momelotinib therapy in myelofibrosis and impact on survival. Am J Hematol 2023; 98:282-289. [PMID: 36349465 DOI: 10.1002/ajh.26778] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
We retrospectively reviewed 72 anemic patients with myelofibrosis (MF; median age 68 years), who were JAK2 inhibitor-naïve at the time of study entry to a phase-1/2 momelotinib clinical trial. Driver mutation profile included JAK2 69%, CALR 17%, MPL 8%, and triple-negative 6%; other mutations included ASXL1 39% and SRSF2 17%. Momelotinib was administered at a median dose of 300 mg daily. Anemia response was assessed by formal criteria and documented in 44% of all patients with hemoglobin levels below the sex-adjusted reference range (n = 72), 48% of those with hemoglobin <10 g/dl (n = 54), and 46% of those who were transfusion-dependent at the time of study entry (n = 28). Anemia response was more likely with post-essential thrombocythemia MF (83% vs 37%; p = .001), lower serum ferritin (p = .003), and shorter time from diagnosis to momelotinib therapy (p = .001); the first two variables were also predictive in transfusion-dependent patients. Post-momelotinib median survival was 3.2 years; in univariate analysis, survival was superior in anemia responders (median 3.8 vs. 2.8 years; p = .14) and in the presence of type 1/like CALR mutation and inferior in the presence of age > 65 years, ASXL1/SRSF2 mutation, unfavorable karyotype, DIPSS-plus high risk, red cell transfusion need and higher serum ferritin. Multivariable analysis confirmed the favorable impact of anemia response on survival (p = .02; HR 0.5, 3/5/10-year survival; 69%/38%/25%). This survival advantage was also noted in transfusion-dependent patients (3.7 vs. 1.9 years; p = .01; HR 0.3) and appeared to be restricted to patients with an unfavorable genetic profile. The current study suggests a short-term survival benefit associated with anemia response in momelotinib-treated patients with MF.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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18
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Gangat N, Ilyas R, McCullough K, Begna KH, Al-Kali A, Patnaik MM, Litzow MR, Hogan WJ, Mangaonkar A, Alkhateeb H, Shah MV, Elliott MA, Foran JM, Badar T, Palmer JM, Hanson CA, Pardanani A, Tefferi A. Predictors of response to venetoclax plus hypomethylating agent therapy and survival in blast-phase myeloproliferative neoplasm. Haematologica 2022; 108:1423-1428. [PMID: 36519330 PMCID: PMC10153526 DOI: 10.3324/haematol.2022.282019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 12/23/2022] Open
Abstract
Not available.
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Affiliation(s)
| | - Rimal Ilyas
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville FL
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville FL
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19
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Tefferi A, Pardanani A, Begna KH, Al-Kali A, Hogan WJ, Litzow MR, Hanson CA, Ketterling RP, Gangat N. Momelotinib for myelofibrosis: 12-year survival data and retrospective comparison to ruxolitinib. Am J Hematol 2022; 97:E433-E435. [PMID: 36057774 DOI: 10.1002/ajh.26714] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis A Hanson
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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20
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Tefferi A, Begna KH, McCullough KB. Tyrosine kinase inhibitors dosing for chronic phase chronic myeloid leukemia: The case for starting low with dasatinib (50 mg/day) and ponatinib (15 mg/day). Am J Hematol 2022; 97:1394-1397. [PMID: 35996356 DOI: 10.1002/ajh.26695] [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: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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21
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Tefferi A, Singh A, Gangat N, Al-Kali A, Alkhateeb H, Shah M, Patnaik MS, Elliott MA, Hogan WJ, Litzow MR, Wolanskyj-Spinner A, Hook CC, Mangaonkar A, Viswanatha D, Chen D, Pardanani A, Begna KH, Ketterling RP. Adverse karyotype subcategories in acute myeloid leukemia display significant differences in mutation composition and transplant-augmented survival. Haematologica 2022; 108:245-249. [PMID: 36073516 PMCID: PMC9827171 DOI: 10.3324/haematol.2022.281495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - David Viswanatha
- Division of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dong Chen
- Division of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rhett P. Ketterling
- Division of Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA,R. P. KETTERLING -
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22
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Tefferi A, Gangat N, Shah M, Alkhateeb H, Patnaik MS, Al-Kali A, Elliott MA, Hogan WJ, Litzow MR, Hook CC, Mangaonkar A, Viswanatha D, Chen D, Pardanani A, Ketterling RP, Begna KH. Daunorubicin-60 vs daunorubicin-90 vs idarubicin-12 for induction chemotherapy in acute myeloid leukemia: a retrospective analysis of the Mayo Clinic experience. Haematologica 2022; 107:2474-2479. [PMID: 35734931 PMCID: PMC9521235 DOI: 10.3324/haematol.2022.281045] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ayalew Tefferi
- Department of Internal Medicine and Division of Hematology
| | - Naseema Gangat
- Department of Internal Medicine and Division of Hematology
| | - Mithun Shah
- Department of Internal Medicine and Division of Hematology
| | | | | | - Aref Al-Kali
- Department of Internal Medicine and Division of Hematology
| | | | | | - Mark R Litzow
- Department of Internal Medicine and Division of Hematology
| | | | | | | | | | | | - Rhett P Ketterling
- Division of Cytogenetics, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Kebede H Begna
- Department of Internal Medicine and Division of Hematology.
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23
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Tefferi A, Gangat N, Al-Kali A, Alkhateeb H, Shah M, Patnaik MS, Elliott MA, Hogan WJ, Litzow MR, Hook CC, Mangaonkar A, Viswanatha D, Chen D, Pardanani A, Ketterling RP, DiNardo CD, Kadia TM, Ravandi F, Sasaki K, Begna KH. A dynamic 3-factor survival model for acute myeloid leukemia that accounts for response to induction chemotherapy. Am J Hematol 2022; 97:1127-1134. [PMID: 35702875 DOI: 10.1002/ajh.26630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/08/2022]
Abstract
The current study was approached with the assumption that response to induction chemotherapy, in acute myeloid leukemia (AML), overshadows pre-treatment risk variables in predicting survival and therefore be used as an anchor for a simplified risk model. We considered 759 intensively-treated patients with AML, not promyelocytic: median age 60 years; primary 66%, secondary 25%, and therapy-related 9%; European LeukemiaNet cytogenetic risk category favorable 8%, intermediate 61%, and adverse 31%. Complete remission with (CR) or without (CRi) count recovery was achieved in 608 (80%) patients. After a median follow-up of 22 months, 503 deaths, 272 relapses, and 257 allogeneic hematopoietic stem cell transplants (AHSCTs) were recorded. Multivariable analysis identified failure to achieve CR/CRi (HR 3.8, 95% CI 3.1-4.8), adverse karyotype (2.2, 1.8-2.8), and age >55 years (2.1, 1.6-2.7) as main risk factors for survival. HR-weighted scoring resulted in four-tiered risk stratification: low (0 points; N=183), intermediate-1 (1 point; N=331), intermediate-2 (2 points; N=117), and high (≥3 points; N=128), with respective median survival (5-year rate) not reached (68%), 34 (37%), 13 (20%), and 5 (5%) months (p <0.001). FLT3-ITD mutation was associated with inferior survival in intermediate-1 (p=0.004) and TP53 in intermediate-2 (p=0.06) and high (p=0.02) risk disease; the latter was fully accounted for by the close association between TP53 mutation and complex/monosomal karyotype while the observations regarding FLT3-ITD were not affected by treatment with midostaurin. AHSCT had a favorable impact on survival, most apparent in intermediate-1 (p<0.001), intermediate-2 (p=0.03), and high (p=0.01) risk disease. The proposed 3-factor survival model offers a novel prototype that is amenable to further enhancement by molecular information and was validated in an external cohort of 1,032 intensively-treated AML patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ayalew Tefferi
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Aref Al-Kali
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Hassan Alkhateeb
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mithun Shah
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mrinal S Patnaik
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Michelle A Elliott
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - William J Hogan
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mark R Litzow
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Christopher C Hook
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Abhishek Mangaonkar
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - David Viswanatha
- Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Dong Chen
- Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Animesh Pardanani
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Hematopathology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | | | - Tapan M Kadia
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas, USA
| | - Koji Sasaki
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas, USA
| | - Kebede H Begna
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, MN
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Gangat N, McCullough K, Johnson I, Al‐Kali A, Begna KH, Patnaik MM, Litzow MR, Hogan W, Shah M, Alkhateeb H, Mangaonkar A, Foran JM, Badar T, Palmer JM, Sproat L, Arana Yi CY, Pardanani A, Tefferi A. Real-world experience with venetoclax and hypomethylating agents in myelodysplastic syndromes with excess blasts. Am J Hematol 2022; 97:E214-E216. [PMID: 35303376 DOI: 10.1002/ajh.26539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Naseema Gangat
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Isla Johnson
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - Mark R. Litzow
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - William Hogan
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Mithun Shah
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - James M. Foran
- Division of Hematology Mayo Clinic Jacksonville Florida USA
| | - Talha Badar
- Division of Hematology Mayo Clinic Jacksonville Florida USA
| | | | - Lisa Sproat
- Division of Hematology Mayo Clinic Scottsdale Arizona USA
| | | | | | - Ayalew Tefferi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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25
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Gangat N, McCullough K, Al-Kali A, Begna KH, Patnaik MM, Litzow MR, Hogan W, Shah M, Alkhateeb H, Mangaonkar A, Foran JM, Palmer JM, Pardanani A, Tefferi A. Limited activity of fedratinib in myelofibrosis patients relapsed/refractory to ruxolitinib 20 mg twice daily or higher: A real-world experience. Br J Haematol 2022; 198:e54-e58. [PMID: 35614565 DOI: 10.1111/bjh.18284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne M Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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26
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Shah MV, Chhetri R, Dholakia R, Kok CH, Gangat N, Alkhateeb HB, Al‐Kali A, Patnaik MM, Baranwal A, Greipp PT, He R, Begna KH, Tiong IS, Wei AH, Hiwase D. Outcomes following venetoclax-based treatment in therapy-related myeloid neoplasms. Am J Hematol 2022; 97:1013-1022. [PMID: 35560061 PMCID: PMC9541522 DOI: 10.1002/ajh.26589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/15/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 12/17/2022]
Abstract
Therapy‐related myeloid neoplasms (t‐MN) are aggressive malignancies in need of effective therapies. The BCL‐2 inhibitor venetoclax represents a paradigm shift in the treatment of acute myeloid leukemia. However, the effectiveness of venetoclax has not been studied in a large cohort of t‐MN. We retrospectively analyzed 378 t‐MN patients, of which 96 (25.4%, 47 therapy‐related acute myeloid leukemia, 1 therapy‐related chronic myelomonocytic leukemia, 48 therapy‐related myelodysplastic syndrome) received venetoclax. Median interval from t‐MN to venetoclax initiation was 2.9 (Interquartile range [IQR] 0.7–12) months, and patients received a median of 3 (IQR 1–4) cycles. The composite complete remission (CRc) rate, median progression‐free survival (PFS), and overall survival (OS) were 39.1%, 4.9 months, and 7 months, respectively. The upfront use of venetoclax and achieving CRc were associated with improved survival, whereas the presence of Chromosome 7 abnormalities was associated with an inferior survival. Neither the TP53‐status nor the percent bone marrow blast predicted the likelihood of CRc or survival. Paired genetic analysis performed at venetoclax initiation and failure did not show the evidence of the selection of the TP53‐mutated clone. In a propensity‐matched analysis, the use of venetoclax‐based regimen as the first‐line therapy was associated with a superior survival compared to hypomethylating agent (HMA)‐based first‐line therapy (9.4 vs. 6.1 months, p = .01). We conclude that the upfront use of venetoclax with HMA improved survival, though PFS and OS remain poor. As the phenotype at diagnosis or the percent blasts did not predict outcomes, venetoclax should be studied in all t‐MN phenotypes.
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Affiliation(s)
| | - Rakchha Chhetri
- Royal Adelaide Hospital Central Adelaide Local Health Network Adelaide South Australia
- University of Adelaide Adelaide South Australia
| | - Ruchita Dholakia
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA
| | - Chung H. Kok
- Precision Medicine Theme South Australian Health and Medical Research Institute (SAHMRI) Adelaide South Australia
| | | | | | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester Minnesota
| | | | | | | | - Rong He
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA
| | | | - Ing Soo Tiong
- Austin Health Melbourne Victoria Australia
- The Alfred Hospital and Monash University Melbourne Victoria Australia
| | - Andrew H. Wei
- The Alfred Hospital and Monash University Melbourne Victoria Australia
- Department of Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Division of Blood Cells and Blood Cancer Walter and Eliza Hall Institute of Medical Research Melbourne Victoria Australia
| | - Devendra Hiwase
- Royal Adelaide Hospital Central Adelaide Local Health Network Adelaide South Australia
- University of Adelaide Adelaide South Australia
- Precision Medicine Theme South Australian Health and Medical Research Institute (SAHMRI) Adelaide South Australia
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Singh A, Al‐Kali A, Begna KH, Litzow MR, Larsen JT, Sher T, Abdelmagid MG, Farrukh F, Reichard KK, Gangat N, Pardanani A, Tefferi A. Midostaurin therapy for advanced systemic mastocytosis: Mayo Clinic experience in 33 consecutive cases. Am J Hematol 2022; 97:630-637. [PMID: 35156231 DOI: 10.1002/ajh.26498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
We retrospectively examined our experience with midostaurin therapy in 33 consecutive patients (median age 68 years; 58% females) with advanced systemic mastocytosis (adv-SM): aggressive SM (ASM; n = 17), SM associated with another hematologic neoplasm (SM-AHN; n = 14) and mast cell leukemia (MCL; n = 2). KITD816V mutation was detected in 84% of the patients and C findings in 91%. Eleven (33%) patients were previously treated with other cytoreductive drugs, including cladribine (n = 4) and imatinib (n = 3). Median time from diagnosis to initiation of midostaurin therapy was 2.2 months (range 0.3-41). Using modified valent criteria, overall response was 42% (53% ASM, 29% SM-AHN, 50% MCL; p = .22), all classified as being major. Responses included ≥50% reduction in bone marrow mast cells in 40% and normalization of serum tryptase in 29%, of evaluated cases. After a median follow-up of 14.6 months from initiation of midostaurin therapy, 7 (21%) deaths, 1 (3%) leukemic progression, and 18 (55%) treatment discontinuations were documented; median duration of midostaurin treatment was 7.9 months (range 0.5-123) and response duration 21.5 months (range 2.9-123). Most frequent side effect was gastrointestinal (51%) while grade 3/4 neutropenia or thrombocytopenia occurred in 12% of patients. Response to treatment was not predicted by KIT mutation (p = .67) or exposure to prior cytoreductive therapy (p = .44). Median survival was longer in midostaurin responders but not significantly (median 26.5 vs. 16 months; p = .15). Findings from the current study are broadly consistent with previously published clinical trial observations.
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Affiliation(s)
- Amritpal Singh
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Mark R. Litzow
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Taimur Sher
- Division of Hematology Mayo Clinic Jacksonville Florida USA
| | | | - Faiqa Farrukh
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Naseema Gangat
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Ayalew Tefferi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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28
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Mangaonkar AA, Lasho TL, Finke C, Ketterling RP, Reichard KK, McCullough K, Gangat N, Al-Kali A, Begna KH, Hogan WH, Litzow MR, Alkhateeb H, Shah M, Pardanani A, Tefferi A, Al Ali NH, Talati C, Sallman D, Padron E, Komrokji R, Patnaik MM. SF3B1-mutant myelodysplastic syndrome/myeloproliferative neoplasms: a unique molecular and prognostic entity. Haematologica 2022; 107:1189-1192. [PMID: 35142154 PMCID: PMC9052897 DOI: 10.3324/haematol.2021.280463] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Terra L Lasho
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Christy Finke
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | | | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester
| | | | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - William H Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Hassan Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Mithun Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester
| | - Najla H Al Ali
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Chetasi Talati
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - David Sallman
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Eric Padron
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Rami Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL.
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester.
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Begna KH, Kittur J, Gangat N, Alkhateeb H, Patnaik MS, Al-Kali A, Elliott MA, Hogan WJ, Litzow MR, Pardanani A, Hanson CA, Ketterling RP, Tefferi A. European LeukemiaNet-defined primary refractory acute myeloid leukemia: the value of allogeneic hematopoietic stem cell transplant and overall response. Blood Cancer J 2022; 12:7. [PMID: 35039473 PMCID: PMC8764050 DOI: 10.1038/s41408-022-00606-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/15/2022] Open
Abstract
We sought to appraise the value of overall response and salvage chemotherapy, inclusive of allogeneic hematopoietic stem cell transplant (AHSCT), in primary refractory acute myeloid leukemia (prAML). For establishing consistency in clinical practice, the 2017 European LeukemiaNet (ELN) defines prAML as failure to attain CR after at least 2 courses of intensive induction chemotherapy. Among 60 consecutive patients (median age 63 years) correspondent with ELN-criteria for prAML, salvage was documented in 48 cases, 30/48 (63%) being administered intensive chemotherapy regimens and 2/48 consolidated with AHSCT as first line salvage. 13/48 (27%) attained response: CR, 7/13 (54%), CRi, 2/13 (15%), MLFS, 4/13 (31%). The CR/CRi rate was 9/48 (19%), with CR rate of 7/48 (15%). On univariate analysis, intermediate-risk karyotype was the only predictor of response (44% vs 17% in unfavorable karyotype; P = 0.04). Administration of any higher-dose (>1 g/m2) cytarabine intensive induction (P = 0.50), intensive salvage chemotherapy (P = 0.72), targeted salvage (FLT3 or IDH inhibitors) (P = 0.42), greater than 1 salvage regimen (P = 0.89), age < 60 years (P = 0.30), and de novo AML (P = 0.10) did not enhance response achievement, nor a survival advantage. AHSCT was performed in 12 patients with (n = 8) or without (n = 4) CR/CRi/MLFS. 1/2/5-year overall survival (OS) rates were 63%/38%/33% in patients who received AHSCT (n = 12) vs 27%/0%/0% in those who achieved CR/CRi/MLFS but were not transplanted (n = 5), vs 14%/0%/0% who were neither transplanted nor achieved CR/CRi/MLFS (n = 43; P < 0.001); the median OS was 18.6, 12.6 and 5.6 months, respectively. Although CR/CRi/MLFS bridged to AHSCT (n = 8), appeared to manifest a longer median OS (20 months), vs (13.4 months) for those with no response consolidated with AHSCT (n = 4), the difference was not significant P = 0.47. We conclude AHSCT as indispensable for securing long-term survival in prAML (p = 0.03 on multivariate analysis), irrespective of response achievement.
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Affiliation(s)
- K H Begna
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - J Kittur
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - N Gangat
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - H Alkhateeb
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - M S Patnaik
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - A Al-Kali
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - M A Elliott
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - W J Hogan
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - M R Litzow
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - A Pardanani
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA
| | - C A Hanson
- Division of Hematopathology, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - R P Ketterling
- Division of Cytogenetics, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Tefferi
- Division of Hematology and Department of Internal Medicine, Rochester, MN, USA.
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Kantarjian HM, Begna KH, Altman JK, Goldberg SL, Sekeres MA, Strickland SA, Arellano ML, Claxton DF, Baer MR, Gautier M, Berman E, Seiter K, Solomon SR, Schiller GJ, Luger SM, Butrym A, Gaidano G, Thomas XG, Montesinos P, Rizzieri DA, Quick DP, Venugopal P, Gaur R, Maness LJ, Kadia TM, Ravandi F, Buyse ME, Chiao JH. Results of a randomized phase 3 study of oral sapacitabine in elderly patients with newly diagnosed acute myeloid leukemia (SEAMLESS). Cancer 2021; 127:4421-4431. [PMID: 34424530 DOI: 10.1002/cncr.33828] [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: 03/11/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is fatal in elderly patients who are unfit for standard induction chemotherapy. The objective of this study was to evaluate the survival benefit of administering sapacitabine, an oral nucleoside analogue, in alternating cycles with decitabine, a low-intensity therapy, to elderly patients with newly diagnosed AML. METHODS This randomized, open-label, phase 3 study (SEAMLESS) was conducted at 87 sites in 11 countries. Patients aged ≥70 years who were not candidates for or chose not to receive standard induction chemotherapy were randomized 1:1 to arm A (decitabine in alternating cycles with sapacitabine) received 1-hour intravenous infusions of decitabine 20 mg/m2 once daily for 5 consecutive days every 8 weeks (first cycle and subsequent odd cycles) and sapacitabine 300 mg twice daily on 3 consecutive days per week for 2 weeks every 8 weeks (second cycle and subsequent even cycles) or to control arm C who received 1-hour infusions of decitabine 20 mg/m2 once daily for 5 consecutive days every 4 weeks. Prior hypomethylating agent therapy for preexisting myelodysplastic syndromes or myeloproliferative neoplasms was an exclusion criterion. Randomization was stratified by antecedent myelodysplastic syndromes or myeloproliferative neoplasms, white blood cell count (<10 × 109 /L and ≥10 × 109 /L), and bone marrow blast percentage (≥50% vs <50%). The primary end point was overall survival (OS). Secondary end points were the rates of complete remission (CR), CR with incomplete platelet count recovery, partial remission, hematologic improvement, and stable disease along with the corresponding durations, transfusion requirements, number of hospitalized days, and 1-year survival. The trial is registered at ClinicalTrials.gov (NCT01303796). RESULTS Between October 2011 and December 2014, 482 patients were enrolled and randomized to receive decitabine administered in alternating cycles with sapacitabine (study arm, n = 241) or decitabine monotherapy (control arm, n = 241). The median OS was 5.9 months on the study arm versus 5.7 months on the control arm (P = .8902). The CR rate was 16.6% on the study arm and 10.8% on the control arm (P = .1468). In patients with white blood cell counts <10 × 109 /L (n = 321), the median OS was higher on the study arm versus the control arm (8.0 vs 5.8 months; P = .145), as was the CR rate (21.5% vs 8.6%; P = .0017). CONCLUSIONS The regimen of decitabine administered in alternating cycles with sapacitabine was active but did not significantly improve OS compared with decitabine monotherapy. Subgroup analyses suggest that patients with baseline white blood cell counts <10 × 109 /L might benefit from decitabine alternating with sapacitabine, with an improved CR rate and the convenience of an oral drug. These findings should be prospectively confirmed.
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Affiliation(s)
- Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jessica K Altman
- Department of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mikkael A Sekeres
- Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, Ohio
| | | | - Martha L Arellano
- Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - David F Claxton
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Marc Gautier
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ellin Berman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen Seiter
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Scott R Solomon
- Northside Hospital Cancer Institute, Leukemia Program, Atlanta, Georgia
| | - Gary J Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Selina M Luger
- Department of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aleksandra Butrym
- Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Gianluca Gaidano
- Division of Hematology, Maggiore della Carita University Hospital, Novara, Italy
| | | | - Pau Montesinos
- La Fe University and Polytechnic Hospital, Valencia, Spain
| | - David A Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Parameswaran Venugopal
- Department of Medicine, Hematology, and Oncology, Rush University Medical Center, Chicago, Illinois
| | - Rakesh Gaur
- St Luke's Cancer Institute, Kansas City, Missouri
| | - Lori J Maness
- Division of Hematology-Oncology Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc E Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
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31
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Tefferi A, Kittur J, Farrukh F, Begna KH, Patnaik MM, Al-Kali A, Elliott MA, Reichard KK, Gangat N, Pardanani A. Cladribine therapy for advanced and indolent systemic mastocytosis: Mayo Clinic experience in 42 consecutive cases. Br J Haematol 2021; 196:975-983. [PMID: 34729775 DOI: 10.1111/bjh.17932] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/15/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
We describe our single institution experience with cladribine therapy in 42 patients with systemic mastocytosis (SM): 22 advanced (adv-SM; median age 65 years, 68% males) and 20 indolent/smouldering SM (ISM/SSM; median age 56 years, 45% males); subcategories included eight aggressive, 13 associated with another haematological neoplasm, one mast cell leukaemia, 17 ISM and three SSM. Overall/major response rates were 77%/45% for adv-SM and 70%/60% for ISM/SSM, and median (range) duration of response 10 (4-75) and 46 (4-140) months respectively. A >50% reduction in bone marrow mast cell burden and serum tryptase level was documented in 63% and 67% of patients with adv-SM and 50% and 46% with ISM/SSM respectively. The presence of KIT proto-oncogene, receptor tyrosine kinase (KIT)D816V predicted response in adv-SM: 17 (90%) of 19 with and none of three without the mutation responded (P < 0·01). Treatment-emergent adverse events were mostly limited to transient cytopenias: Grade 3/4 neutropenia, thrombocytopenia, or lymphopenia occurred in 27%, 27% and 27% of patients with adv-SM, and 5%, 5% and 30% with ISM/SSM respectively. The present study provides practical information that might be considered when making treatment choices between cladribine and newer KIT-targeted therapies and identifies the absence of KITD816V as a potential marker of cladribine resistance in advanced SM; the latter observation needs confirmation in a larger study.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jaya Kittur
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Faiqa Farrukh
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kebede H Begna
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kaaren K Reichard
- Division of Hematopathology, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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32
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Koster MJ, Kourelis T, Reichard KK, Kermani TA, Beck DB, Cardona DO, Samec MJ, Mangaonkar AA, Begna KH, Hook CC, Oliveira JL, Nasr SH, Tiong BK, Patnaik MM, Burke MM, Michet CJ, Warrington KJ. Clinical Heterogeneity of the VEXAS Syndrome: A Case Series. Mayo Clin Proc 2021; 96:2653-2659. [PMID: 34489099 DOI: 10.1016/j.mayocp.2021.06.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
The objective of this study is to describe the clinical features and outcomes of patients with the newly defined vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome. Nine men with somatic mutations in the UBA1 gene were identified; the most frequent variant was p.Met41Thr (7 of 9, 78%). The median age at VEXAS diagnosis was 74 (67, 76.5) years, and patients had a median duration of symptoms for 4 years before diagnosis. Refractory constitutional symptoms (88%), ear and nose chondritis (55%), and inflammatory arthritis (55%) were common clinical features. Vasculitis was noted in 44%. All patients had significantly elevated inflammatory markers and macrocytic anemia. Thrombocytopenia was present in 66% at diagnosis of VEXAS. Eight patients had bone marrow biopsies performed. All bone marrows were hypercellular, and there was vacuolization of the erythroid (100%) or myeloid precursors (75%). Glucocorticoids attenuated symptoms at prednisone doses ≥20 mg per day, but no other immunosuppressive agent showed consistent long-term control of disease. One patient with coexisting plasma-cell myeloma received plasma-cell-directed therapy with improvement of the inflammatory response, which is a novel finding. In conclusion, VEXAS syndrome is a clinically heterogeneous, treatment-refractory inflammatory condition caused by somatic mutation of the UBA1 gene. Patients often present with overlapping rheumatologic manifestations and persistent hematologic abnormalities. As such, internists and subspecialists, including pathologists, should be aware of this condition to avert diagnostic delay, now that the etiology of this syndrome is known.
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Affiliation(s)
- Matthew J Koster
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN.
| | - Taxiarchis Kourelis
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN
| | - Tanaz A Kermani
- Department of Internal Medicine, Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Santa Monica, CA
| | - David B Beck
- National Institutes of Health, National Human Genome Research Institute, Bethesda, MD
| | | | - Matthew J Samec
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
| | | | - Kebede H Begna
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - C Christopher Hook
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Jennifer L Oliveira
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Benedict K Tiong
- Department of Internal Medicine, Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Santa Monica, CA
| | - Mrinal M Patnaik
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Michelle M Burke
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Clement J Michet
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Kenneth J Warrington
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
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33
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Begna KH, Kittur J, Yui J, Gangat N, Patnaik MM, Al-Kali A, Elliott MA, Hogan WJ, Litzow MR, Hook CC, Wolanskyj AP, Howard MT, Hanson CA, Ketterling RP, Pardanani AD, Tefferi A. De novo isolated myeloid sarcoma: comparative analysis of survival in 19 consecutive cases. Br J Haematol 2021; 195:413-416. [PMID: 34346084 DOI: 10.1111/bjh.17742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/11/2021] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 01/31/2023]
Abstract
Institutional database search (1999-2020) for acute myeloid leukaemia (AML) identified 109 cases of myeloid sarcoma (MS), of which 19 were isolated and presented de novo. The latter displayed longer survival (median 78 months), compared to MS with synchronous intramedullary AML (n = 32; median 16 months) and de novo AML without MS (n = 729; median 22 months; P = 0·13). However, the difference in survival was no longer apparent after accounting for bone marrow cytogenetic risk status (P = 0·67). Treatment-induced MS tumour resolution was not affected by the presence of intramedullary disease (P = 0·61). The current study clarifies the prognosis of de novo isolated MS, in the context of AML.
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Affiliation(s)
- Kebede H Begna
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaya Kittur
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer Yui
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher C Hook
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexandra P Wolanskyj
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew T Howard
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis A Hanson
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rhett P Ketterling
- Division of Cytogenetics, Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh D Pardanani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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34
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Gangat N, Guglielmelli P, Szuber N, Begna KH, Patnaik MM, Litzow MR, Al‐Kali A, Foran JM, Palmer JM, Alkhateeb H, Elliott MA, Hanson CA, Pardanani A, Mannelli F, Vannucchi AM, Tefferi A. Venetoclax with azacitidine or decitabine in blast-phase myeloproliferative neoplasm: A multicenter series of 32 consecutive cases. Am J Hematol 2021; 96:781-789. [PMID: 33844862 PMCID: PMC8251544 DOI: 10.1002/ajh.26186] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 03/28/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022]
Abstract
Venetoclax (Ven) combined with a hypomethylating agent (HMA) has now emerged as an effective treatment regimen for acute myeloid leukemia, in both de novo and relapsed/refractory setting. The current multicenter study retrospectively examined Ven + HMA treatment outcome among 32 patients (median age 69 years; 59% males) with blast‐phase myeloproliferative neoplasm (MPN‐BP). Pre‐leukemic phenotype included essential thrombocythemia (ET)/post‐ET myelofibrosis (34%), polycythemia vera (PV)/post‐PV myelofibrosis (38%) and primary myelofibrosis (28%). Twenty‐nine study patients were fully annotated cytogenetically and molecularly (NGS): 69% harbored complex karyotype and/or mutations, including TP53 (41%), IDH1/2 (21%), ASXL1 (21%), N/KRAS (14%), SRSF2 (10%), EZH2 (10%) and U2AF1 (7%). All patients received Ven combined with either azacitidine (n = 12) or decitabine (n = 20); either up front (n = 23) or after failing another induction therapy (n = 9). Complete remission with (CR) or without (CRi) count recovery was achieved in 14 (44%) patients and was more likely to occur in the absence of pre‐leukemic PV/post‐PV myelofibrosis phenotype (p < .01), complex karyotype (p < .01) or K/NRAS (p = .03) mutations; seven of eight patients (88%) without vs four of 21 (19%) with complex karyotype or K/NRAS mutation achieved CR/CRi (p < .01); all 11 informative patients with pre‐leukemic PV/post‐PV myelofibrosis phenotype displayed complex karyotype (p < .01). In contrast, neither TP53 (p = .45) nor IDH1/2 (p = .63) mutations affected response. Compared to historical controls treated with HMA alone (n = 26), the CR/CRi rate (44% vs 4%) and median survival (8 vs 5.5 months) were more favorable with Ven + HMA, but without significant difference in overall survival. Importantly, six patients with CR/CRi subsequently received allogeneic hematopoietic stem cell transplant (AHSCT). Note, Ven + HMA produces robust CR/CRi rates in MPN‐BP, especially in the absence of RAS mutations and complex karyotype, thus enabling AHSCT, in some patients.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi University of Florence Florence Italy
| | - Natasha Szuber
- Department of Hematology Université de Montréal Quebec Canada
| | | | | | - Mark R. Litzow
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - James M. Foran
- Division of Hematology Mayo Clinic Jacksonville Florida USA
| | | | | | | | | | | | - Francesco Mannelli
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi University of Florence Florence Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi University of Florence Florence Italy
| | - Ayalew Tefferi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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35
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Begna KH, Gangat N, Al‐Kali A, Litzow MR, Hogan WJ, Patnaik MM, Pardanani A, Hook CC, Wolanskyj AP, Elliott MA, Hanson CA, Ketterling RP, Tefferi A. Acute myeloid leukemia after age 70 years: A retrospective comparison of survival following treatment with intensive versus HMA ± venetoclax chemotherapy. Am J Hematol 2021; 96:E108-E111. [PMID: 33527451 DOI: 10.1002/ajh.26112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/10/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Aref Al‐Kali
- Divisions of Hematology Mayo Clinic Rochester Minnesota
| | | | | | | | | | | | | | | | | | - Rhett P. Ketterling
- Laboratory Genetics and Genomics, Departments of Internal and Laboratory Medicine Mayo Clinic Rochester Minnesota
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36
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Duong VH, Begna KH, Kashanian S, Sweet K, Wang ES, Caddell R, Shafer DA, Singh ZN, Baer MR, Al-Kali A. Favorable outcomes of acute leukemias of ambiguous lineage treated with hyperCVAD: a multi-center retrospective study. Ann Hematol 2020; 99:2119-2124. [PMID: 32676733 DOI: 10.1007/s00277-020-04179-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/07/2020] [Accepted: 07/09/2020] [Indexed: 01/12/2023]
Abstract
Acute leukemias of ambiguous lineage (ALAL) are rare hematologic malignancies with poor outcomes. Retrospective studies have suggested that acute lymphoblastic leukemia (ALL) regimens are more effective than acute myeloid leukemia (AML) regimens. We retrospectively examined the effectiveness of the widely-used adult ALL regimen hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyperCVAD) as initial therapy in patients with ALAL at five academic institutions. Twenty-five patients were identified, including 23 with mixed phenotype acute leukemia (MPAL) and two with acute undifferentiated leukemia. Five of 8 tested (63%) had FLT3-ITD and 3 of 25 (12%) were Philadelphia chromosome-positive. The complete remission (CR) rate was 76%, with CR with incomplete count recovery (CRi) in an additional 8%, for an overall response rate of 84%. Median number of cycles to CR/CRi was 1. There were no deaths in the first 30 days. Of the 21 patients achieving CR or CRi, 14 (66%) proceeded to allogeneic hematopoietic stem cell transplantation. With a median follow-up time of 31.6 months, median overall survival for the entire cohort was not reached, and the estimated 2-year survival was 63%. HyperCVAD can be considered an effective and tolerable front-line regimen for patients with ALAL, and warrants further prospective study.
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Affiliation(s)
- Vu H Duong
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, 22 S. Greene St, S9D04B, Baltimore, MD, 21201, USA.
| | | | - Sarah Kashanian
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, 22 S. Greene St, S9D04B, Baltimore, MD, 21201, USA
| | - Kendra Sweet
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ryan Caddell
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Danielle A Shafer
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Zeba N Singh
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, 22 S. Greene St, S9D04B, Baltimore, MD, 21201, USA
| | - Maria R Baer
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, 22 S. Greene St, S9D04B, Baltimore, MD, 21201, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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37
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Abu Rmilah AA, Lin G, Begna KH, Friedman PA, Herrmann J. Risk of
QTc
prolongation among cancer patients treated with tyrosine kinase inhibitors. Int J Cancer 2020; 147:3160-3167. [DOI: 10.1002/ijc.33119] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Anan A. Abu Rmilah
- William J. von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic Rochester Minnesota USA
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Grace Lin
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Kebede H. Begna
- Department of Internal Medicine, Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Joerg Herrmann
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
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38
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Bubik RJ, Barth DM, Hook C, Wolf RC, Muth JM, Mara K, Patnaik MS, Pruthi RK, Marshall AL, Litzow MR, Elliott MA, Hogan WJ, Shah MV, Begna KH, Alkhateeb H, Pardanani A, Ashrani AA, Call TG, Rivera CE, Camoriano JK, Go RS, Wolanskyj-Spinner AP, Parikh SA. Clinical outcomes of adults with hemophagocytic lymphohistiocytosis treated with the HLH-04 protocol: a retrospective analysis. Leuk Lymphoma 2020; 61:1592-1600. [PMID: 32157935 DOI: 10.1080/10428194.2020.1737684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of pathologic immune activation in children that is increasingly being recognized in adults. Efficacy data for the HLH-04 protocol in adults is lacking. This study retrospectively analyzed 31 adult patients, median age 46 years, who received HLH-04 from 1/1/2004 to 5/1/2018. HLH etiology included malignancy (n = 9), autoimmune (n = 8), infection (n = 8), and idiopathic (n = 6). Eighteen patients were evaluable for response at week 4 with 7 having no response, 11 reaching partial response, and 0 reaching complete response (CR). Six patients eventually achieved CR at a median 195 days. The 1-year overall survival (OS) was 35% and median OS was 3.2 months. Univariate analysis showed shorter survival for hemoglobin <9 g/dL (HR 4.29, p = 0.003), platelets <100 × 109/L (HR 4.06, p = 0.027), ANC <1 × 109/L (HR 5.24, p = 0.001), and total bilirubin >1.2 mg/dL (HR 3.30, p = 0.022). Outcomes of adults treated with HLH-04 remain dismal and newer treatment modalities are needed.
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Affiliation(s)
| | - Dylan M Barth
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Robert C Wolf
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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39
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Anagnostou T, Knudson RA, Pearce KE, Meyer RG, Pitel BA, Peterson JF, Baughn LB, Reichard KK, Ketterling RP, Kloft‐Nelson SM, Knutson DL, Khan SP, Gangat N, Litzow MR, Hogan WJ, Wolanskyj A, Al‐Kali A, Begna KH, Elliott M, Pardanani A, Foran J, Shah M, Tefferi A, Alkhateeb H, Halling K, Rodriguez V, Greipp PT, Patnaik MM. Clinical utility of fluorescence in situ hybridization-based diagnosis of BCR-ABL1 like (Philadelphia chromosome like) B-acute lymphoblastic leukemia. Am J Hematol 2020; 95:E68-E72. [PMID: 31919873 DOI: 10.1002/ajh.25729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Theodora Anagnostou
- Bone Marrow Transplantation Service, Department of MedicineMemorial Sloan Kettering Cancer Center Mayo Clinic Rochester Minnesota
| | - Ryan A. Knudson
- Cytogenetics Core Laboratory, Medical Genome FacilityMayo Clinic Rochester Minnesota
| | - Kathryn E. Pearce
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Reid G. Meyer
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Beth A. Pitel
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Jess F. Peterson
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Linda B. Baughn
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Kaaren K. Reichard
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Rhett P. Ketterling
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Sara M. Kloft‐Nelson
- Cytogenetics Core Laboratory, Medical Genome FacilityMayo Clinic Rochester Minnesota
| | - Darlene L. Knutson
- Cytogenetics Core Laboratory, Medical Genome FacilityMayo Clinic Rochester Minnesota
| | - Shakila P. Khan
- Division of Pediatric Hematology/OncologyMayo Clinic Rochester Minnesota
| | | | | | | | | | - Aref Al‐Kali
- Division of HematologyMayo Clinic Rochester Minnesota
| | | | | | | | - James Foran
- Division of HematologyMayo Clinic Jacksonville Florida
| | - Mithun Shah
- Division of HematologyMayo Clinic Rochester Minnesota
| | | | | | - Kevin Halling
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology/OncologyMayo Clinic Rochester Minnesota
| | - Patricia T. Greipp
- Department of Laboratory Medicine and Pathology, Genomics LaboratoryMayo Clinic Rochester Minnesota
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40
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He R, Devine DJ, Tu ZJ, Mai M, Chen D, Nguyen PL, Oliveira JL, Hoyer JD, Reichard KK, Ollila PL, Al-Kali A, Tefferi A, Begna KH, Patnaik MM, Alkhateeb H, Viswanatha DS. Hybridization capture-based next generation sequencing reliably detects FLT3 mutations and classifies FLT3-internal tandem duplication allelic ratio in acute myeloid leukemia: a comparative study to standard fragment analysis. Mod Pathol 2020; 33:334-343. [PMID: 31471587 PMCID: PMC7051912 DOI: 10.1038/s41379-019-0359-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/12/2023]
Abstract
FLT3-internal tandem duplication occurs in 20-30% of acute myeloid leukemia and confers an adverse prognosis with its allelic ratio being a key risk stratifier. The US Food and Drug Administration recently approved FLT3 inhibitors midostaurin and gilteritinib in FLT3 mutation-positive acute myeloid leukemia. Historically, FLT3 was tested by fragment analysis, which has become the standard method endorsed by international guidelines. However, next generation sequencing is increasingly used at acute myeloid leukemia diagnosis given its ability to simultaneously evaluate multiple clinically informative markers. As FLT3-internal tandem duplication detection was known to be challenging by next generation sequencing and the results carry profound prognostic and therapeutic implications, it is important to thoroughly examine its performance in FLT3-internal tandem duplication detection and allelic ratio classification. In a comparative study with fragment analysis, we retrospectively reviewed our experience using a custom-designed, hybridization capture-based, targeted next generation sequencing panel. Among 7902 cases, FLT3-internal tandem duplication was detected in 335 with variable sizes (3-231 bp) and insertion sites. Fragment analysis was also performed in 402 cases, demonstrating 100% concordance in FLT3-internal tandem duplication detection. In 136 dual-tested, positive cases, 128/136 (94%) exhibited concordant high/low allelic ratio classifications. The remaining 6% showed borderline low allelic ratio by next generation sequencing. The two methods were concordant in FLT3-tyrosine kinase domain mutation detection at the hotspot D835/I836 targeted by fragment analysis. Furthermore, seven mutations which may benefit from FLT3 inhibitor therapy were detected by next generation sequencing, in regions not covered by fragment analysis. Our study demonstrates that using a hybridization capture-based chemistry and optimized bioinformatics pipeline, next generation sequencing can reliably detect FLT3-internal tandem duplication and classify its allelic ratio for acute myeloid leukemia risk stratification. Next generation sequencing also exhibits superior comprehensiveness in FLT3 mutation detection and may further improve personalized, targeted therapy in acute myeloid leukemia.
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Affiliation(s)
- Rong He
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Daniel J Devine
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Zheng Jin Tu
- Biomedical statistics and informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ming Mai
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dong Chen
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jennifer L Oliveira
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - James D Hoyer
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kaaren K Reichard
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul L Ollila
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Hassan Alkhateeb
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David S Viswanatha
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Alkharabsheh O, Patnaik MM, Gangat N, Begna KH, Alkhateeb HB, Shah MV, Hogan WJ, He R, Greipp P, Nguyen PL, Litzow MR, Al-Kali A. Impact of marrow blasts percentage on high-grade myelodysplastic syndrome assessed using revised international prognostic scoring system. Ann Hematol 2020; 99:513-518. [PMID: 31974678 DOI: 10.1007/s00277-020-03917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Clinical trials and treatment guidelines for myelodysplastic syndrome depend on several prognostic scoring systems to stratify patients by risk. These include different variables: the degree of cytopenia, percentage of bone marrow blasts, and cytogenetics. Little is known about the impact of bone marrow blasts in patients with adverse cytogenetics. In this retrospective study, we analyzed 536 patients with high-grade myelodysplastic syndrome to examine the differences in survival for patients with different percentages of bone marrow blasts. The median overall survival in patients with ≥ 5% marrow blasts was not statistically different from that for patients with < 5% marrow blasts; however, the former group had a higher risk of progression to acute myeloid leukemia (p < 0.001). Therefore, cytogenetics is the most important factor in our prognostic tools to determine survival outcomes for patients with myelodysplastic syndrome, and patients with high-risk disease have poor prognosis irrespective of their marrow blasts percentage.
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Affiliation(s)
- Omar Alkharabsheh
- Division of Medical Oncology, University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mithun Vinod Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - William J Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Phuong L Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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42
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He R, Devine DJ, Tu ZJ, Mai M, Chen D, Nguyen PL, Oliveira JL, Hoyer JD, Reichard KK, Ollila PL, Al-Kali A, Tefferi A, Begna KH, Patnaik MM, Alkhateeb H, Viswanatha DS. Correction to: Hybridization capture-based next-generation sequencing reliably detects FLT3 mutations and classifies FLT3-internal tandem duplication allelic ratio in acute myeloid leukemia: a comparative study to standard fragment analysis. Mod Pathol 2020; 33:514. [PMID: 31591496 PMCID: PMC7608401 DOI: 10.1038/s41379-019-0378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Rong He
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Daniel J. Devine
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Zheng Jin Tu
- 0000 0004 0459 167Xgrid.66875.3aBiomedical statistics and informatics, Mayo Clinic College of Medicine, Rochester, MN USA ,0000 0001 0675 4725grid.239578.2Present Address: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH USA
| | - Ming Mai
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Dong Chen
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Phuong L. Nguyen
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Jennifer L. Oliveira
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - James D. Hoyer
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Kaaren K. Reichard
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Paul L. Ollila
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Aref Al-Kali
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Ayalew Tefferi
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Kebede H. Begna
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Mrinal M. Patnaik
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - Hassan Alkhateeb
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematology, Mayo Clinic College of Medicine, Rochester, MN USA
| | - David S. Viswanatha
- 0000 0004 0459 167Xgrid.66875.3aDivision of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN USA
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Hsieh RW, Ravindran A, Hook CC, Begna KH, Ashrani AA, Pruthi RK, Marshall AL, Hogan W, Litzow M, Hoyer J, Oliveira JL, Vishnu P, Call TG, Al-Kali A, Patnaik M, Gangat N, Pardanani A, Tefferi A, Go RS. Etiologies of Extreme Thrombocytosis: A Contemporary Series. Mayo Clin Proc 2019; 94:1542-1550. [PMID: 31378229 DOI: 10.1016/j.mayocp.2019.01.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/25/2018] [Accepted: 01/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. PATIENTS AND METHODS We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. RESULTS A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. CONCLUSION Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.
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Affiliation(s)
- Ronan W Hsieh
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA
| | - Aishwarya Ravindran
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - James Hoyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN.
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44
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Al-Kali A, Zblewski D, Foran JM, Patnaik MS, Larrabee BR, Gangat N, Begna KH, Elliott MA, Hogan WJ, Tefferi A, Litzow MR, Go RS. Outcome of Myelodysplastic Syndromes Over Time in the United States: A National Cancer Data Base Study From 2004-2013. Mayo Clin Proc 2019; 94:1467-1474. [PMID: 31378228 DOI: 10.1016/j.mayocp.2019.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/31/2019] [Accepted: 02/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the changes in overall outcome of patients with myelodysplastic syndromes (MDSs) after approval of several treatments. PATIENTS AND METHODS We identified 54,953 MDS cases in the National Cancer Data Base diagnosed from January 1, 2004, through December 31, 2013, using International Classification of Diseases for Oncology, 3rd edition, codes 9980, 9982-9983, 9985-9987, 9989, 9991-9992. Overall survival and different subgroups were studied over 3 periods of diagnoses (2004-2006, 2007-2009, and 2010-2013). RESULTS Median age at diagnosis was 76 years. The most common subtype was MDS-unclassifiable, which represented 55.6% of all cases. We found that males, older patients, patients with refractory anemia with excess blasts, Medicare insurance recipients, and those treated at nonacademic centers had the worse survival (P<.001). Overall survival did not improve over time, except in younger patients (<40 years old). CONCLUSION In the past decade, overall outcome of MDS did not improve despite the advent of new therapies. More studies are needed to understand the impact of newly approved treatments on the outcome of patients with MDS.
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Affiliation(s)
- Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN.
| | | | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Beth R Larrabee
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
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Szuber N, Mudireddy M, Nicolosi M, Penna D, Vallapureddy RR, Lasho TL, Finke C, Begna KH, Elliott MA, Hook CC, Wolanskyj AP, Patnaik MM, Hanson CA, Ketterling RP, Sirhan S, Pardanani A, Gangat N, Busque L, Tefferi A. 3023 Mayo Clinic Patients With Myeloproliferative Neoplasms: Risk-Stratified Comparison of Survival and Outcomes Data Among Disease Subgroups. Mayo Clin Proc 2019; 94:599-610. [PMID: 30824279 DOI: 10.1016/j.mayocp.2018.08.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/16/2018] [Accepted: 08/06/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To document the Mayo Clinic decades-long experience with myeloproliferative neoplasms (MPNs) and provide mature risk-stratified survival data and disease complication estimates. PATIENTS AND METHODS All Mayo Clinic patients with World Health Organization-defined MPNs constituted the core study group and included those with polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). RESULTS A total of 3023 consecutive patients (median age, 62 years; range, 18-96 years) were considered: 665 PV, 1076 ET, and 1282 PMF. From October 27, 1967, through December 29, 2017, 1631 deaths (54%), 183 leukemic transformations (6%), 244 fibrotic progressions (14%), and 516 thrombotic events (17%) were recorded. Median overall survival (OS) was 18 years for ET, 15 years for PV, and 4.4 years for PMF (P<.05 for all intergroup comparisons). Inferior survival was documented in patients with ET diagnosed more recently (post-1990) (P<.001), whereas survival data were time independent in PV and PMF. After conventional risk stratification, OS in low-risk ET and low-risk PV were superimposed (P=.89) but each differed significantly from that of age- and sex-matched controls (P<.001). Leukemia-free survival was similar for ET and PV (P=.22) and significantly worse with PMF (P<.001). Compared with ET, PV was associated with higher risk of fibrotic progression (P<.001). Thrombosis risk after diagnosis was highest in PV and lowest in PMF (P=.002 for PV vs ET; P=.56 for ET vs PMF; and P=.001 for PV vs PMF). CONCLUSION This study provides the most mature survival and outcomes data in MPNs and highlights MPN subgroup risk categorization as key in appraising disease natural history. The OS was only marginally better in ET compared with PV, and PV displayed a higher risk of thrombosis and fibrotic progression.
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Affiliation(s)
- Natasha Szuber
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mythri Mudireddy
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Maura Nicolosi
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Domenico Penna
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rangit R Vallapureddy
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Terra L Lasho
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Christy Finke
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Kebede H Begna
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Michelle A Elliott
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - C Christopher Hook
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Alexandra P Wolanskyj
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Curtis A Hanson
- Division of Hematopathology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Shireen Sirhan
- Division of Hematology, Jewish General Hospital, Montréal, Québec, Canada; Chronic Myeloid Leukemia and Myeloproliferative Neoplasms Quebec Research Group
| | - Animesh Pardanani
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Lambert Busque
- Chronic Myeloid Leukemia and Myeloproliferative Neoplasms Quebec Research Group; Department of Laboratory Hematology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN.
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46
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DeLoughery EP, Ravindran A, Ashrani AA, Begna KH, Hook CC, Marshall AL, Pruthi RK, Wolanskyj-Spinner AP, Go RS. Patterns and utility of vitamin B12 and folate testing in patients with isolated thrombocytopenia. Ann Hematol 2019; 98:1993-1994. [PMID: 30877374 DOI: 10.1007/s00277-019-03666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | - Aishwarya Ravindran
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Aneel A Ashrani
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - C Christopher Hook
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ariela L Marshall
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rajiv K Pruthi
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
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47
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Park JY, Guo W, Al-Hijji M, El Sabbagh A, Begna KH, Habermann TM, Witzig TE, Lewis BR, Lerman A, Herrmann J. Acute coronary syndromes in patients with active hematologic malignancies - Incidence, management, and outcomes. Int J Cardiol 2019; 275:6-12. [PMID: 30318297 PMCID: PMC10853038 DOI: 10.1016/j.ijcard.2018.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/22/2018] [Accepted: 10/02/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cancer and cardiovascular diseases are the two leading causes of death in industrialized countries. Optimal management of life-threatening presentations of both of their diseases can pose significant challenges. The current study aimed to address the incidence, management, and outcome of acute coronary syndromes (ACS) in patients with active hematological malignancies. METHODS This retrospective registry-based cohort study included adults with active leukemia or lymphoma who were hospitalized at Mayo Clinic Rochester from 01/01/2004 to 12/31/2014. The diagnosis of ST-segment elevation MI (STEMI) or non-ST-segment elevation MI (NSTEMI) was made based on the 3rd Universal Definition for MI, or of unstable angina (UA) in the absence of cardiac troponin elevation. Main outcome measures included all-cause, cardiac, and non-cardiac death in-hospital and at one year. RESULTS Of 5300 adult patients with active hematological malignancies, 73 (1.4%) were diagnosed with an ACS (78.1% NSTEMI and 13.7% STEMI). 17.5% and 40% of NSTEMI and STEMI patients underwent coronary angiography, with percutaneous coronary intervention in 5.3% and 30%, respectively. While >80% of patients received β-blocker therapy, only half of all and <50% of patients managed "medically" received antiplatelet, anticoagulant, and/or statin therapy. The in-hospital and 1-year mortality was 21.9% and 58.9%, respectively, of which 25% and 15% were cardiac in etiology. Aspirin, beta-blocker, statins, and angiotensin-converting enzyme inhibitor/angiotensin-II receptor blocker were associated with better mortality outcomes. CONCLUSIONS In a large, contemporary study of adults with active hematologic malignancies, ACS was uncommon, but commonly managed not in keeping with societal guideline recommendations.
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Affiliation(s)
- Jae Yoon Park
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Wei Guo
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA; Peking University People's Hospital, Department of Emergency Medicine, Beijing, China
| | - Mohammed Al-Hijji
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Abdallah El Sabbagh
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Kebede H Begna
- Division of Hematology/Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Thomas M Habermann
- Division of Hematology/Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Thomas E Witzig
- Division of Hematology/Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Bradley R Lewis
- Department of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
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48
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Tefferi A, Szuber N, Vallapureddy RR, Begna KH, Patnaik MM, Elliott MA, Christopher Hook C, Wolanskyj AP, Hanson CA, Ketterling RP, Pardanani A, Gangat N. Decreased survival and increased rate of fibrotic progression in essential thrombocythemia chronicled after the FDA approval date of anagrelide. Am J Hematol 2019; 94:5-9. [PMID: 30252953 DOI: 10.1002/ajh.25294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 01/01/2023]
Abstract
First-line cytoreductive drug of choice in high risk essential thrombocythemia (ET) is currently hydroxyurea, a practice based on the results of a randomized study; second-line drugs of choice include pegylated interferon-α, busulfan and anagrelide. Anagrelide clinical trials were pioneered by the late Murray N. Silverstein (1928-1998) of the Mayo Clinic whose studies led to FDA approval in March 1997. The current study represents a retrospective examination of the potential impact of anagrelide therapy on survival and disease complications in ET. 1076 patients with ET were considered (median age 58 years; females 63%); risk distribution, according to the international prognostic score for ET (IPSET), was 28% high, 42% intermediate, and 30% low. Overall (OS), myelofibrosis-free (MFFS) and thrombosis-free survival data were compared for ET patients diagnosed before and after the 1997 FDA approval date for anagrelide; a significant difference was apparent in OS (P = .006; HR 1.4, 95% CI 1.1-1.7) and MFFS (P < .001; HR 4.2, 95% CI 2.7-6.5), in favor of patients diagnosed prior to 1997; the difference was sustained during multivariable analysis that included IPSET. Similarly stratified survival data in polycythemia vera (n = 665) and primary myelofibrosis (n = 1282) showed no similar impact on survival (P = .3 and .17, respectively). The current study represents a retrospective analysis and suggests significantly decreased OS and MFFS in ET patients diagnosed after the FDA approval date of anagrelide. Whether or not anagrelide therapy was to blame for the worsening of OS and MFFS over time cannot be assumed and requires validation in a prospective study.
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Affiliation(s)
- Ayalew Tefferi
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | - Natasha Szuber
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | | | | | | | | | - Rhett P. Ketterling
- Departments of Internal and Laboratory Medicine, Laboratory Genetics and Genomics; Mayo Clinic; Rochester Minnesota
| | | | - Naseema Gangat
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
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49
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Alkharabsheh O, Saadeh SS, Patnaik MS, Alkhateeb H, Gangat N, Begna KH, Hogan WJ, Greipp PT, He R, Nguyen PL, Litzow MR, Al-Kali A. Impact of clone size with a single cytogenetic abnormality on the revised International Prognostic Scoring System in myelodysplastic syndromes. Am J Hematol 2018; 93:E398-E401. [PMID: 30218541 DOI: 10.1002/ajh.25287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Naseema Gangat
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | - Patricia T. Greipp
- Division of Laboratory Genetics and Genomics; Mayo Clinic; Rochester Minnesota
- Department of Clinical Genomics; Mayo Clinic; Rochester Minnesota
| | - Rong He
- Division of Hematopathology; Mayo Clinic; Rochester Minnesota
| | | | - Mark R. Litzow
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Aref Al-Kali
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Begna KH, Ali W, Gangat N, Elliott MA, Al-Kali A, Litzow MR, Hook CC, Wolanskyj AP, Hogan WJ, Patnaik MM, Pardanani A, Zblewski DL, Chen D, He R, Viswanatha D, Hanson CA, Ketterling RP, Tefferi A. A novel predictive model of outcome in acute myeloid leukemia without favorable karyotype based on treatment strategy, karyotype and FLT3-ITD mutational status. Am J Hematol 2018; 93:E401-E404. [PMID: 30230610 DOI: 10.1002/ajh.25290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Kebede H. Begna
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Walid Ali
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Michelle A. Elliott
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Mark R. Litzow
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - C. Christopher Hook
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Alexandra P. Wolanskyj
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - William J. Hogan
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Mrinal M. Patnaik
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Darci L. Zblewski
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Dong Chen
- Division of Hematopathology, Department of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - David Viswanatha
- Division of Hematopathology, Department of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Curtis A. Hanson
- Division of Hematopathology, Department of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Rhett P. Ketterling
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
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