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Mencia-Trinchant N, Hu Y, Alas MA, Ali F, Wouters BJ, Lee S, Ritchie EK, Desai P, Guzman ML, Roboz GJ, Hassane DC. Minimal Residual Disease Monitoring of Acute Myeloid Leukemia by Massively Multiplex Digital PCR in Patients with NPM1 Mutations. J Mol Diagn 2017; 19:537-548. [PMID: 28525762 DOI: 10.1016/j.jmoldx.2017.03.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 12/27/2022] Open
Abstract
The presence of minimal residual disease (MRD) is widely recognized as a powerful predictor of therapeutic outcome in acute myeloid leukemia (AML), but methods of measurement and quantification of MRD in AML are not yet standardized in clinical practice. There is an urgent, unmet need for robust and sensitive assays that can be readily adopted as real-time tools for disease monitoring. NPM1 frameshift mutations are an established MRD marker present in half of patients with cytogenetically normal AML. However, detection is complicated by the existence of hundreds of potential frameshift insertions, clonal heterogeneity, and absence of sequence information when the NPM1 mutation is identified using capillary electrophoresis. Thus, some patients are ineligible for NPM1 MRD monitoring. Furthermore, a subset of patients with NPM1-mutated AML will have false-negative MRD results because of clonal evolution. To simplify and improve MRD testing for NPM1, we present a novel digital PCR technique composed of massively multiplex pools of insertion-specific primers that selectively detect mutated but not wild-type NPM1. By measuring reaction end points using digital PCR technology, the resulting single assay enables sensitive and specific quantification of most NPM1 exon 12 mutations in a manner that is robust to clonal heterogeneity, does not require NPM1 sequence information, and obviates the need for maintenance of hundreds of type-specific assays and associated plasmid standards.
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Affiliation(s)
- Nuria Mencia-Trinchant
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yang Hu
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Maria Antonina Alas
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Fatima Ali
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Bas J Wouters
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sangmin Lee
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ellen K Ritchie
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Pinkal Desai
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Monica L Guzman
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gail J Roboz
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Duane C Hassane
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York.
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