1
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Yoshimi A, Noellke P, Starý J, Kállay K, Smith O, Locatelli F, Buechner J, Bodova I, Sevilla J, Schmugge M, Bierings M, Masmas T, Dworzak M, Labarque V, Pawelec K, Jahnukainen K, Polychronopoulou S, Kjollerstrom P, Kavcic M, Erlacher M, Niemeyer CM, Strahm B. Comparison of outcomes of immunosuppressive therapy with rabbit versus horse antithymocyte globulin and cyclosporine a in children with acquired severe aplastic anemia. Am J Hematol 2024. [PMID: 38622880 DOI: 10.1002/ajh.27334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Ayami Yoshimi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Noellke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Starý
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Krisztián Kállay
- Dept. of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Owen Smith
- National Children's Cancer Service, Children's Health Ireland, Dublin, Ireland
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Hearth, Rome, Italy
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Ivana Bodova
- Bone Marrow Transplantation Unit, Detská fakultná nemocnica s poliklinikou v Bratislave, Bratislava, Slovakia
| | - Julian Sevilla
- Hematology and Hemotherapy Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Markus Schmugge
- Department of Hematology, Oncology and Stemcell Transplantation, University Children's Hospital, Zurich, Switzerland
| | - Marc Bierings
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology and Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Tania Masmas
- Pediatric Hematopoietic Stem Cell Transplantation and Immunodeficiency, The Child and Adolescent Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Dworzak
- St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, and St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Veerle Labarque
- Department of Pediatric Hematology and Oncology, University Hospital Leuven Gasthuisberg, Leuven, Belgium
| | - Katarzyna Pawelec
- Department of Paediatric Transplantology, Haematology and Oncology, Warsaw Medical University, Warsaw, Poland
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and SCT Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology Oncology (T.A.O.), Aghia Sophia Children's Hospital, Athens, Greece
| | - Paula Kjollerstrom
- Pediatric Hematology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Marko Kavcic
- Unit of Oncology and Haematology, University Children's Hospital, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Miriam Erlacher
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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2
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Mark C, Meshinchi S, Joyce B, Gibson B, Harrison C, Bergmann AK, Goemans BF, Pronk CJH, Lapillonne H, Leverger G, Antoniou E, Schneider M, Attarbaschi A, Dworzak M, Stary J, Tomizawa D, Ebert S, Lejman M, Kolb EA, Schmiegelow K, Hasle H, Abla O. Treatment outcomes of childhood PICALM::MLLT10 acute leukaemias. Br J Haematol 2024; 204:576-584. [PMID: 37743097 DOI: 10.1111/bjh.19067] [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: 03/01/2023] [Revised: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023]
Abstract
The prognostic impact of PICALM::MLLT10 status in childhood leukaemia is not well described. Ten International Berlin Frankfurt Münster-affiliated study groups and the Children's Oncology Group collaborated in this multicentre retrospective study. The presence of the PICALM::MLLT10 fusion gene was confirmed by fluorescence in situ hybridization and/or RNA sequencing at participating sites. Ninety-eight children met the study criteria. T-cell acute lymphoblastic leukaemia (T-ALL) and acute myeloid leukaemia (AML) predominated 55 (56%) and 39 (40%) patients, respectively. Most patients received a chemotherapy regimen per their disease phenotype: 58% received an ALL regimen, 40% an AML regimen and 1% a hybrid regimen. Outcomes for children with PICALM::MLLT10 ALL were reasonable: 5-year event-free survival (EFS) 67% and 5-year overall survival (OS) 76%, but children with PICALM::MLLT10 AML had poor outcomes: 5-year EFS 22% and 5-year OS 26%. Haematopoietic stem cell transplant (HSCT) did not result in a significant improvement in outcomes for PICALM::MLLT10 AML: 5-year EFS 20% for those who received HSCT versus 23% for those who did not (p = 0.6) and 5-year OS 37% versus 36% (p = 0.7). In summary, this study confirms that PICALM::MLLT10 AML is associated with a dismal prognosis and patients cannot be salvaged with HSCT; exploration of novel therapeutic options is warranted.
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Affiliation(s)
- Catherine Mark
- Division of Hematology/Oncology, Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Centre, Seattle, Washington, USA
| | - Brooklyn Joyce
- Division of Hematology/Oncology, Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda Gibson
- Royal Hospital for Sick Children, Glasgow, Scotland, UK
| | | | | | - Bianca F Goemans
- Princess Maxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Guy Leverger
- Hôpital d'enfants Armand Trousseau, Paris, France
| | | | | | - Andishe Attarbaschi
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Michael Dworzak
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Centre, National Centre for Child Health and Development, Tokyo, Japan
| | - Sabine Ebert
- Clinic of Pediatric Hematology and Oncology, University Medical Centre, Hamburg, Germany
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland
| | - E Anders Kolb
- Nemours Children's Hospital, Wilmington, Delaware, USA
| | | | - Henrik Hasle
- Hematology/Oncology, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Oussama Abla
- Division of Hematology/Oncology, Toronto Hospital for Sick Children, Toronto, Ontario, Canada
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3
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Erlacher M, Andresen F, Sukova M, Stary J, De Moerloose B, Bosch JVDWT, Dworzak M, Seidel MG, Polychronopoulou S, Beier R, Kratz CP, Nathrath M, Frühwald MC, Göhring G, Bergmann AK, Mayerhofer C, Lebrecht D, Ramamoorthy S, Yoshimi A, Strahm B, Wlodarski MW, Niemeyer CM. Spontaneous remission and loss of monosomy 7: a window of opportunity for young children with SAMD9L syndrome. Haematologica 2024; 109:422-430. [PMID: 37584291 PMCID: PMC10828767 DOI: 10.3324/haematol.2023.283591] [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: 05/25/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
Monosomy 7 is the most common cytogenetic abnormality in pediatric myelodysplastic syndrome (MDS) and associated with a high risk of disease progression. However, in young children, spontaneous loss of monosomy 7 with concomitant hematologic recovery has been described, especially in the presence of germline mutations in SAMD9 and SAMD9L genes. Here, we report on our experience of close surveillance instead of upfront hematopoietic stem cell transplantation (HSCT) in seven patients diagnosed with SAMD9L syndrome and monosomy 7 at a median age of 0.6 years (range, 0.4-2.9). Within 14 months from diagnosis, three children experienced spontaneous hematological remission accompanied by a decrease in monosomy 7 clone size. Subclones with somatic SAMD9L mutations in cis were identified in five patients, three of whom attained hematological remission. Two patients acquired RUNX1 and EZH2 mutations during the observation period, of whom one progressed to myelodysplastic syndrome with excess of blasts (MDS-EB). Four patients underwent allogeneic HSCT at a median time of 26 months (range, 14-40) from diagnosis for MDSEB, necrotizing granulomatous lymphadenitis, persistent monosomy 7, and severe neutropenia. At last follow-up, six patients were alive, while one passed away due to transplant-related causes. These data confirm previous observations that monosomy 7 can be transient in young children with SAMD9L syndrome. However, they also indicate that delaying HSCT poses a substantial risk of severe infection and disease progression. Finally, surveillance of patients with SAMD9L syndrome and monosomy 7 is critical to define the evolving genetic landscape and to determine the appropriate timing of HSCT (clinicaltrials gov. Identifier: NCT00662090).
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Affiliation(s)
- Miriam Erlacher
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg.
| | - Felicia Andresen
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Martina Sukova
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent
| | | | - Michael Dworzak
- St. Anna Children's Hospital, Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria; St. Anna Children's Cancer Research Institute, Vienna
| | - Markus G Seidel
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology (T.A.O.), Aghia Sophia Children's Hospital, Athens, Greece
| | - Rita Beier
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover
| | - Christian P Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover
| | - Michaela Nathrath
- Department of Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany; Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich
| | - Michael C Frühwald
- Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg
| | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover
| | - Anke K Bergmann
- Department of Human Genetics, Hannover Medical School, Hannover
| | - Christina Mayerhofer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Dirk Lebrecht
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Senthilkumar Ramamoorthy
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Ayami Yoshimi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Marcin W Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg
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4
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Ramamoorthy S, Lebrecht D, Schanze D, Schanze I, Wieland I, Andrieux G, Metzger P, Hess M, Albert MH, Borkhardt A, Bresters D, Buechner J, Catala A, De Haas V, Dworzak M, Erlacher M, Hasle H, Jahnukainen K, Locatelli F, Masetti R, Stary J, Turkiewicz D, Vinci L, Wlodarski MW, Yoshimi A, Boerries M, Niemeyer CM, Zenker M, Flotho C. Biallelic inactivation of the NF1 tumour suppressor gene in juvenile myelomonocytic leukaemia: Genetic evidence of driver function and implications for diagnostic workup. Br J Haematol 2024; 204:595-605. [PMID: 37945316 DOI: 10.1111/bjh.19190] [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: 06/20/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Juvenile myelomonocytic leukaemia (JMML) is characterized by gene variants that deregulate the RAS signalling pathway. Children with neurofibromatosis type 1 (NF-1) carry a defective NF1 allele in the germline and are predisposed to JMML, which presumably requires somatic inactivation of the NF1 wild-type allele. Here we examined the two-hit concept in leukaemic cells of 25 patients with JMML and NF-1. Ten patients with JMML/NF-1 exhibited a NF1 loss-of-function variant in combination with uniparental disomy of the 17q arm. Five had NF1 microdeletions combined with a pathogenic NF1 variant and nine carried two compound-heterozygous NF1 variants. We also examined 16 patients without clinical signs of NF-1 and no variation in the JMML-associated driver genes PTPN11, KRAS, NRAS or CBL (JMML-5neg) and identified eight patients with NF1 variants. Three patients had microdeletions combined with hemizygous NF1 variants, three had compound-heterozygous NF1 variants and two had heterozygous NF1 variants. In addition, we found a high incidence of secondary ASXL1 and/or SETBP1 variants in both groups. We conclude that the clinical diagnosis of JMML/NF-1 reliably indicates a NF1-driven JMML subtype, and that careful NF1 analysis should be included in the genetic workup of JMML even in the absence of clinical evidence of NF-1.
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Affiliation(s)
- Senthilkumar Ramamoorthy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Lebrecht
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Denny Schanze
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Ina Schanze
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Ilse Wieland
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maria Hess
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Michael H Albert
- Department of Pediatric Hematology and Oncology, Dr. v. Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Immunology, University of Dusseldorf, Dusseldorf, Germany
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Albert Catala
- Department of Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Valerie De Haas
- Diagnostic Laboratory/DCOG Laboratory, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Michael Dworzak
- St. Anna Children's Cancer Research Institute, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Miriam Erlacher
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jan Stary
- Department of Pediatric Hematology/ Oncology, Charles University and Univ Hospital Motol, Prague, Czech Republic
| | - Dominik Turkiewicz
- Department of Pediatric Oncology/Hematology, Skåne University Hospital, Lund, Sweden
| | - Luca Vinci
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcin W Wlodarski
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ayami Yoshimi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
| | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
| | - Martin Zenker
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
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5
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Ronceray L, Dworzak M, Dieckmann K, Ebetsberger-Dachs G, Glogova E, Haas OA, Jones N, Nebral K, Moser R, Lion T, Meister B, Panzer-Grümayer R, Strehl S, Peters C, Pötschger U, Urban C, Mann G, Attarbaschi A. Prospective use of molecular minimal residual disease for risk stratification in children and adolescents with acute lymphoblastic leukemia : Long-term results of the AIEOP-BFM ALL 2000 trial in Austria. Wien Klin Wochenschr 2023:10.1007/s00508-023-02249-6. [PMID: 37535134 DOI: 10.1007/s00508-023-02249-6] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
Since 1979 Austrian children and adolescents with acute lymphoblastic leukemia (ALL) have been treated according to protocols of the Berlin-Frankfurt-Münster (BFM) study group. The Associazione Italiana di Ematologia e Oncologia Pediatrica and BFM (AIEOP-BFM) ALL 2000 study was designed to prospectively study patient stratification into three risk groups using minimal residual disease (MRD) on two time points during the patient's early disease course. The MRD levels were monitored by detection of clone-specific rearrangements of the immunoglobulin and T‑cell receptor genes applying a quantitative polymerase chain reaction-based technique. The 7‑year event-free survival (EFS) and overall survival rates for all 608 Austrian patients treated between June 1999 and December 2009 within the AIEOP-BFM 2000 study were 84 ± 2% and 91 ± 1%, respectively, with a median observation time of 6.58 years. Event-free survival for patients with precursor B‑cell and T‑cell ALL were 84 ± 2% (n = 521) and 84 ± 4% (n = 87; p = 0.460), respectively. The MRD assessment was feasible in 94% of the patients and allowed the definition of precursor B‑cell ALL patients with a low, intermediate or high risk of relapse even on top of clinically relevant subgroups. A similar finding with respect to MRD relevance in T‑ALL patients was not possible due to the small number of patients and events. Since this pivotal international AIEOP-BFM ALL 2000 trial, molecular response to treatment has been continuously used with additional refinements to stratify patients into different risk groups in all successive trials of the AIEOP-BFM ALL study group.
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Affiliation(s)
- Leila Ronceray
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria
| | - Michael Dworzak
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Georg Ebetsberger-Dachs
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Evgenia Glogova
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Oskar A Haas
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - Neil Jones
- Department of Pediatrics and Adolescent Medicine, University Clinics Salzburg, Salzburg, Austria
| | - Karin Nebral
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - Reinhard Moser
- Department of Pediatrics and Adolescent Medicine, State Hospital Leoben, Leoben, Austria
| | - Thomas Lion
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - Bernhard Meister
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sabine Strehl
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Christina Peters
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria
| | - Ulrike Pötschger
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Christian Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg Mann
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria.
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria.
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6
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Campbell M, Kiss C, Zimmermann M, Riccheri C, Kowalczyk J, Felice MS, Kuzmanovic M, Kovacs G, Kosmidis H, Gonzalez A, Bilic E, Castillo L, Kolenova A, Jazbec J, Popa A, Konstantinov D, Kappelmayer J, Szczepanski T, Dworzak M, Buldini B, Gaipa G, Marinov N, Rossi J, Nagy A, Gaspar I, Stary J, Schrappe M. Childhood Acute Lymphoblastic Leukemia: Results of the Randomized Acute Lymphoblastic Leukemia Intercontinental-Berlin-Frankfurt-Münster 2009 Trial. J Clin Oncol 2023:JCO2201760. [PMID: 37141547 DOI: 10.1200/jco.22.01760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE The International Berlin-Frankfurt-Münster (BFM) study group conducted a study on pediatric acute lymphoblastic leukemia (ALL). Minimal residual disease (MRD) was assessed using flow cytometry (FCM), and the impact of early intensification and methotrexate (MTX) dose on survival was evaluated. PATIENTS AND METHODS We included 6,187 patients younger than 19 years. MRD by FCM refined the risk group definition previously used in the ALL intercontinental-BFM 2002 study on the basis of age, WBC count, unfavorable genetic aberrations, and treatment response measured morphologically. Patients at intermediate risk (IR) and high risk (HR) were randomly assigned to protocol augmented protocol I phase B (IB) versus IB regimen. MTX doses of 2 versus 5 g/m2 every 2 weeks, four times, were evaluated in precursor B-cell-ALL (pcB-ALL) IR. RESULTS The 5-year event-free survival (EFS ± SE) and overall survival (OS ± SE) rates were 75.2% ± 0.6% and 82.6% ± 0.5%, respectively. Their values in risk groups were standard risk (n = 624), 90.7% ± 1.4% and 94.7% ± 1.1%; IR (n = 4,111), 77.9% ± 0.7% and 85.7% ± 0.6%; and HR (n = 1,452), 60.8% ± 1.5% and 68.4% ± 1.4%, respectively. MRD by FCM was available in 82.6% of cases. The 5-year EFS rates in patients randomly assigned to protocol IB (n = 1,669) and augmented IB (n = 1,620) were 73.6% ± 1.2% and 72.8% ± 1.2%, respectively (P = .55), while those in patients receiving MTX doses of 2 g/m2 (n = 1,056) and MTX 5 g/m2 (n = 1,027) were 78.8% ± 1.4% and 78.9% ± 1.4%, respectively (P = .84). CONCLUSION The MRDs were successfully assessed using FCM. An MTX dose of 2 g/m2 was effective in preventing relapse in non-HR pcB-ALL. Augmented IB showed no advantages over the standard IB.
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Affiliation(s)
- Myriam Campbell
- Department of Pediatric Hematology and Oncology, Hospital Roberto del Rio, Universidad de Chile, Chilean National Pediatric Oncology Group, PINDA, Santiago, Chile
| | - Csongor Kiss
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Cecilia Riccheri
- Argentine Group for the Treatment of Acute Leukemia, GATLA, Buenos Aires, Argentina
| | - Jerzy Kowalczyk
- Department of Pediatric, Hematology, Oncology, and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Maria S Felice
- Hematology and Oncology Department, Hospital de Pediatría Prof. Dr Juan P. Garrahan, SAHOP, Buenos Aires, Argentina
| | - Milos Kuzmanovic
- Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Faculty of Medicine, Belgrade, Serbia
| | - Gabor Kovacs
- 2nd Department of Pediatrics Semmelweis University, Budapest, Hungary
| | - Helen Kosmidis
- Pediatric and Adolescent Oncology Clinic, Children's Hospital MITERA, Athens, Greece
| | | | - Ernest Bilic
- School of Medicine Division of Pediatric Hematology and Oncology, University Hospital Center, University of Zagreb, Zagreb, Croatia
| | - Luis Castillo
- Pediatric Hemato-Oncology Department, Hospital Pereira Rossell, Pérez Scremini Foundation, Montevideo, Uruguay
| | - Alexandra Kolenova
- Department of Pediatric Hematology and Oncology, National Institute of Children's Diseases and Medical School, Comenius University, Bratislava, Slovakia
| | - Janez Jazbec
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Alexander Popa
- Pediatric Oncology and Hematology Research Institute of N.N.Blokhin National Cancer Research Center, Center, Moscow, Russia
| | - Dobrin Konstantinov
- Pediatric Hematology & Oncology Department, University Hospital "Tsaritsa Johanna-ISUL", Sofia, Bulgaria
| | - Janos Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michael Dworzak
- St Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Barbara Buldini
- Mother and Child's Health Department, Division of Pediatric Hematology, Oncology and Stem Cell Transplant, University of Padova, Padova, Veneto, Italy
| | - Giuseppe Gaipa
- Centro Tettamanti, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Neda Marinov
- Chilean National Pediatric Oncology Group, PINDA, Hospital Roberto del Rio/Universidad de Chile, Santiago, Chile
- Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Jorge Rossi
- Immunology and Rheumatology Department, Hospital de Pediatría Prof. Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Attila Nagy
- Department of Interventional Epidemiology, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Gaspar
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Jan Stary
- Department of Pediatric Hematology and Oncology Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Schrappe
- Department of Pediatric and Adolescent Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
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7
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Sembill S, Ampatzidou M, Chaudhury S, Dworzak M, Kalwak K, Karow A, Kiani A, Krumbholz M, Luesink M, Naumann-Bartsch N, De Moerloose B, Osborn M, Schultz KR, Sedlacek P, Giona F, Zwaan CM, Shimada H, Versluijs B, Millot F, Hijiya N, Suttorp M, Metzler M. Management of children and adolescents with chronic myeloid leukemia in blast phase: International pediatric CML expert panel recommendations. Leukemia 2023; 37:505-517. [PMID: 36707619 PMCID: PMC9991904 DOI: 10.1038/s41375-023-01822-2] [Citation(s) in RCA: 4] [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: 10/06/2022] [Revised: 12/24/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
Treatment of chronic myeloid leukemia has improved significantly with the introduction of tyrosine kinase inhibitors (TKIs), and treatment guidelines based on numerous clinical trials are available for chronic phase disease. However for CML in the blast phase (CML-BP), prognosis remains poor and treatment options are much more limited. The spectrum of treatment strategies for children and adolescents with CML-BP has largely evolved empirically and includes treatment principles derived from adult CML-BP and pediatric acute leukemia. Given this heterogeneity of treatment approaches, we formed an international panel of pediatric CML experts to develop recommendations for consistent therapy in children and adolescents with this high-risk disease based on the current literature and national standards. Recommendations include detailed information on initial diagnosis and treatment monitoring, differentiation from Philadelphia-positive acute leukemia, subtype-specific selection of induction therapy, and combination with tyrosine kinase inhibitors. Given that allogeneic hematopoietic stem cell transplantation currently remains the primary curative intervention for CML-BP, we also provide recommendations for the timing of transplantation, donor and graft selection, selection of a conditioning regimen and prophylaxis for graft-versus-host disease, post-transplant TKI therapy, and management of molecular relapse. Management according to the treatment recommendations presented here is intended to provide the basis for the design of future prospective clinical trials to improve outcomes for this challenging disease.
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Affiliation(s)
- Stephanie Sembill
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Maria Ampatzidou
- Department of Pediatric Hematology-Oncology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Sonali Chaudhury
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Dworzak
- St. Anna Kinderspital, Department of Pediatrics, Medical University, Vienna, Austria
| | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Axel Karow
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Alexander Kiani
- Medizinische Klinik IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Manuela Krumbholz
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Maaike Luesink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Nora Naumann-Bartsch
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael Osborn
- Women's and Children's Hospital and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kirk R Schultz
- Division of Hematology/Oncology/BMT, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Fiorina Giona
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Christian Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,ITCC Hematological Malignancies Committee, Rotterdam, the Netherlands
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | | | - Frederic Millot
- Departments of Paediatric Oncology/Haematology, Poitiers University Hospital, Poitiers, France
| | - Nobuko Hijiya
- Division of Pediatric Hematology/Oncology/Transplant, Columbia University Irving Medical Center, New York, NY, USA
| | - Meinolf Suttorp
- Pediatric Hemato-Oncology, Medical Faculty, Technical University Dresden, Dresden, Germany
| | - Markus Metzler
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany. .,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
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8
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Gidl A, Füreder A, Benesch M, Dworzak M, Engstler G, Jones N, Kropshofer G, Pötschger U, Poyer F, Tamesberger M, Witt V, Mann G, Attarbaschi A. Incidence and Risk Factors of Venous Thromboembolism in Childhood Acute Lymphoblastic Leukaemia - a Population-Based Analysis of the Austrian Berlin-Frankfurt-Münster (BFM) Study Group. Pediatr Hematol Oncol 2023; 40:181-191. [PMID: 35848787 DOI: 10.1080/08880018.2022.2089791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a well-known complication of the treatment of pediatric acute lymphoblastic leukemia (ALL). We analyzed 1026 ALL patients 1-18-years-old, who were enrolled into the AIEOP-BFM ALL 2000 or 2009 studies in Austria, with regard to the incidence and risk factors of VTE. The 2.5-year cumulative incidence (CI) of VTE ≥ grade 2 was 4%±1% (n = 36/1026). Twenty VTE (56%) were found in the central nervous system (19 cerebral venous sinus and 1 cortical vein thrombosis), and 16 (44%) at other sites (7 deep vein thromboses (DVT) of the lower extremity, 4 DVT of the upper extremity, 4 central venous line-thromboses, 1 pulmonary embolism). Most VTE occurred during induction and early consolidation therapy (81%) and were associated with L-asparaginase within 4 and corticosteroids withing 1 week(s) preceding the event (89 and 86%, respectively). In multivariable analysis, two independent risk factors were found. Patients 10-18-years-old had an increased (hazard-ratio: 2.156, p = 0.0389), whereas treatments in trial AIEOP-BFM ALL 2009 had a lower risk for VTE (hazard-ratio: 0.349, p = 0.0270). In conclusion, the 2.5-year CI of VTE among our pediatric patient cohort was <5% and adolescent age was the main patient-related risk factor. This older age group might benefit from primary prophylactic measures.
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Affiliation(s)
- Anna Gidl
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Anna Füreder
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Michael Dworzak
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Gernot Engstler
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Neil Jones
- Department of Pediatrics and Adolescent Medicine, University Clinics Salzburg, Salzburg, Austria
| | - Gabriele Kropshofer
- Division of Pediatric Hematology and Oncology and Stem Cell Transplantation, Department of Pediatrics and Adolescent Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Fiona Poyer
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Melanie Tamesberger
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Volker Witt
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Georg Mann
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
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9
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Bertrums EJM, Smith JL, Harmon L, Ries RE, Wang YCJ, Alonzo TA, Menssen AJ, Chisholm KM, Leonti AR, Tarlock K, Ostronoff F, Pogosova-Agadjanyan EL, Kaspers GJL, Hasle H, Dworzak M, Walter C, Muhlegger N, Morerio C, Pardo L, Hirsch B, Raimondi S, Cooper TM, Aplenc R, Gamis AS, Kolb EA, Farrar JE, Stirewalt D, Ma X, Shaw TI, Furlan SN, Brodersen LE, Loken MR, Van den Heuvel-Eibrink MM, Zwaan CM, Triche TJ, Goemans BF, Meshinchi S. Comprehensive molecular and clinical characterization of NUP98 fusions in pediatric acute myeloid leukemia. Haematologica 2023. [PMID: 36815378 PMCID: PMC10388277 DOI: 10.3324/haematol.2022.281653] [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: 06/27/2022] [Indexed: 02/24/2023] Open
Abstract
NUP98 fusions c omprise a family o f rare r ecurrent a lterations i n A ML, associated w ith adverse outcomes. To define the underlying biology and clinical implications of this family of fusions, we performed comprehensive transcriptome, epigenome, and immunophenotypic profiling of 2,235 children and young adults with AML and identified 160 NUP98 rearrangements (7.2%), including 108 NUP98-NSD1 (4.8%), 32 NUP98-KDM5A (1.4%) and 20 NUP98-X cases (0.9%) with 13 different fusion partners. Fusion partners defined disease characteristics and biology; patients with NUP98-NSD1 or NUP98-KDM5A had distinct immunophenotypic, transcriptomic, and epigenomic profiles. Unlike the two most prevalent NUP98 fusions, NUP98-X variants are typically not cryptic. Furthermore, NUP98-X cases are associated with WT1 mutations, and have epigenomic profiles that resemble either NUP98- NSD1 or NUP98-KDM5A. Cooperating FLT3-ITD and WT1 mutations define NUP98-NSD1, and chromosome 13 aberrations are highly enriched in NUP98-KDM5A. Importantly, we demonstrate that NUP98 fusions portend dismal overall survival, with the noteworthy exception of patients bearing abnormal chr13.
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Affiliation(s)
- Eline J M Bertrums
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology/Hematology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands; Oncode Institute, Utrecht.
| | - Jenny L Smith
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Lauren Harmon
- Department of Epigenetics, Van Andel Institute, Grand Rapids, MI
| | - Rhonda E Ries
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Yi-Cheng J Wang
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA; Children's Oncology Group, Monrovia, CA
| | - Todd A Alonzo
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA; Children's Oncology Group, Monrovia, CA
| | | | - Karen M Chisholm
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Amanda R Leonti
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Katherine Tarlock
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA
| | - Fabiana Ostronoff
- Intermountain Blood and Marrow Transplant and Acute Leukemia Program, Intermountain Healthcare, Salt Lake City, UT
| | | | - Gertjan J L Kaspers
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, The Netherlands; Dutch Childhood Oncology Group
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Dworzak
- Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; St. Anna Kinderspital, Department of Pediatrics, Medical University of Vienna, Vienna
| | - Christiane Walter
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen
| | - Nora Muhlegger
- Children's Cancer Research Institute, Medical University of Vienna, Vienna
| | - Cristina Morerio
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa
| | | | - Betsy Hirsch
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Susana Raimondi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Todd M Cooper
- Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA
| | - Richard Aplenc
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alan S Gamis
- Division of Hematology/Oncology, Children's Mercy Kansas City, Kansas City, MO
| | - Edward A Kolb
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Jason E Farrar
- Arkansas Children's Research Institute and Department of Pediatrics, Hematology/Oncology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Derek Stirewalt
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Xiaotu Ma
- Computational Biology Department, St. Jude Children's Research Hospital, Memphis, TN
| | - Tim I Shaw
- Computational Biology Department, St. Jude Children's Research Hospital, Memphis, TN
| | - Scott N Furlan
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | | | | | | | - C Michel Zwaan
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology/Hematology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands; Dutch Childhood Oncology Group
| | - Timothy J Triche
- Department of Epigenetics, Van Andel Institute, Grand Rapids, MI, USA; Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA; Department of Pediatrics, Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA; Children's Oncology Group, Monrovia, CA, USA; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA.
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10
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Poyer F, Dieckmann K, Dworzak M, Tamesberger M, Haas O, Jones N, Nebral K, Köhrer S, Moser R, Kropshofer G, Peters C, Urban C, Mann G, Pötschger U, Attarbaschi A. Second malignant neoplasms after treatment of 1487 children and adolescents with acute lymphoblastic leukemia—A population‐based analysis of the Austrian ALL‐BFM Study Group. eJHaem 2022; 3:940-948. [PMID: 36051012 PMCID: PMC9421960 DOI: 10.1002/jha2.488] [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] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Fiona Poyer
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
| | - Karin Dieckmann
- Department of RadiotherapyMedical University of ViennaViennaAustria
| | - Michael Dworzak
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Melanie Tamesberger
- Department of Pediatrics and Adolescent MedicineKepler University Hospital LinzLinzAustria
| | - Oskar Haas
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
- Labdia DiagnosticsViennaAustria
| | - Neil Jones
- Department of Pediatrics and Adolescent MedicineUniversity Clinics SalzburgSalzburgAustria
| | | | - Stefan Köhrer
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
- Labdia DiagnosticsViennaAustria
| | - Reinhard Moser
- Department of Pediatrics and Adolescent MedicineState Hospital LeobenLeobenAustria
| | - Gabriele Kropshofer
- Division of Pediatric Hematology and Oncology and Stem Cell Transplantation, Department of Pediatrics and Adolescent MedicineMedical University of InnsbruckInnsbruckAustria
| | - Christina Peters
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
| | - Christian Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Georg Mann
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Ulrike Pötschger
- St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's HospitalMedical University of ViennaViennaAustria
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11
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Poyer F, Füreder A, Holter W, Peters C, Boztug H, Dworzak M, Engstler G, Friesenbichler W, Köhrer S, Lüftinger R, Ronceray L, Witt V, Pichler H, Attarbaschi A. Relapsed acute lymphoblastic leukaemia after allogeneic stem cell transplantation: a therapeutic dilemma challenging the armamentarium of immunotherapies currently available (case reports). Ther Adv Hematol 2022; 13:20406207221099468. [PMID: 35646299 PMCID: PMC9134426 DOI: 10.1177/20406207221099468] [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: 01/16/2022] [Accepted: 04/19/2022] [Indexed: 12/05/2022] Open
Abstract
While survival rates in paediatric acute lymphoblastic leukaemia (ALL) nowadays
exceed 90%, systemic ALL relapse, especially after haemopoietic stem cell
transplantation (HSCT), is associated with a poor outcome. As there is currently
no standardized treatment for this situation, individualized treatment is often
pursued. Exemplified by two clinical scenarios, the aim of this article is to
highlight the challenge for treating physicians to find a customized treatment
strategy integrating the role of conventional chemotherapy, immunotherapeutic
approaches and second allogeneic HSCT. Case 1 describes a 2-year-old girl with
an early isolated bone marrow relapse of an infant
KMT2A-rearranged B-cell precursor ALL after allogeneic HSCT.
After bridging chemotherapy and lymphodepleting chemotherapy, chimeric antigen
receptor (CAR) T-cells (tisagenlecleucel) were administered for remission
induction, followed by a second HSCT from the 9/10 human leukocyte antigen
(HLA)-matched mother. Case 2 describes a 16-year-old girl with a late, isolated
bone marrow relapse of B-cell precursor ALL after allogeneic HSCT who
experienced severe treatment toxicities including stage IV renal insufficiency.
After dose-reduced bridging chemotherapy, CAR T-cells (tisagenlecleucel) were
administered for remission induction despite a CD19- clone without
prior lymphodepletion due to enhanced persisting toxicity. This was followed by
a second allogeneic HSCT from the haploidentical mother. While patient 2
relapsed around Day + 180 after the second HSCT, patient 1 is still in complete
remission >360 days after the second HSCT. Both cases demonstrate the
challenges associated with systemic ALL relapse after first allogeneic HSCT,
including chemotherapy-resistant disease and persisting organ damage inflicted
by previous therapy. Immunotherapeutic approaches, such as CAR T-cells, can
induce remission and enable a second allogeneic HSCT. However, optimal therapy
for systemic ALL relapse after first HSCT remains to be defined.
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Affiliation(s)
- Fiona Poyer
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Anna Füreder
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Holter
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Children’s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Christina Peters
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Children’s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Heidrun Boztug
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Dworzak
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Children’s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Gernot Engstler
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Waltraud Friesenbichler
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Köhrer
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Children’s Cancer Research Institute, St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Roswitha Lüftinger
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Leila Ronceray
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Volker Witt
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Herbert Pichler
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andishe Attarbaschi
- Department of Pediatric Haematology and Oncology, St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
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12
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Dworzak M, Rowland CA, Yap GPA, Bloch ED. Controlling phase in low-nuclearity calixarene-capped porous coordination cages with ligand functionalization. CrystEngComm 2022. [DOI: 10.1039/d2ce00861k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Porosity in low-nuclearity coordination cages is relatively rare as cages with larger pore sizes are usually targeted as a way to increase gas adsorption capabilities in this promising class of...
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13
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Klein K, Beverloo HB, Zimmermann M, Raimondi SC, von Neuhoff C, de Haas V, van Weelderen R, Cloos J, Abrahamsson J, Bertrand Y, Dworzak M, Fynn A, Gibson B, Ha SY, Harrison CJ, Hasle H, Elitzur S, Leverger G, Maschan A, Razzouk B, Reinhardt D, Rizzari C, Smisek P, Creutzig U, Kaspers GJL. Prognostic significance of chromosomal abnormalities at relapse in children with relapsed acute myeloid leukemia: A retrospective cohort study of the Relapsed AML 2001/01 Study. Pediatr Blood Cancer 2022; 69:e29341. [PMID: 34532968 DOI: 10.1002/pbc.29341] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In addition to treatment response, cytogenetic and molecular aberrations are the most important prognostic factors in children with de novo acute myeloid leukemia (AML). However, little is known about cytogenetics at the time of relapse. METHODS This international study analyzed the prognostic value of cytogenetic profiles and karyotypic changes in pediatric relapsed AML in relation to the probability of event-free (pEFS) and overall survival (pOS). For this purpose, cytogenetic reports from all patients registered on the Relapsed AML 2001/01 Study were reviewed and classified. RESULTS Cytogenetic information at relapse was available for 403 (71%) of 569 registered patients. Frequently detected aberrations at relapse were t(8;21)(q22;q22) (n = 60) and inv(16)(p13.1q22)/t(16;16)(p13.1;q22) (n = 24), both associated with relatively good outcome (4-year pOS 59% and 71%, respectively). Monosomy 7/7q-, t(9;11)(p22;q23), t(10;11)(p12;q23), and complex karyotypes were associated with poor outcomes (4-year pOS 17%, 19%, 22%, and 22%, respectively). Of 261 (65%) patients for whom cytogenetic data were reliable at both diagnosis and relapse, pEFS was inferior for patients with karyotypic instability (n = 128, 49%), but pOS was similar. Unstable karyotypes with both gain and loss of aberrations were associated with inferior outcome. Early treatment response, time to relapse, and cytogenetic profile at time of relapse were the most important prognostic factors, both outweighing karytoypic instability per se. CONCLUSION The cytogenetic subgroup at relapse is an independent risk factor for (event-free) survival. Cytogenetic assessment at the time of relapse is of high importance and may contribute to improved risk-adapted treatment for children with relapsed AML.
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Affiliation(s)
- Kim Klein
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H Berna Beverloo
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Martin Zimmermann
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Susana C Raimondi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christine von Neuhoff
- Department of Pediatric Hematology-Oncology, University Hospital Essen, Essen, Germany
| | - Valérie de Haas
- Clinical laboratory, Dutch Childhood Oncology Group, The Hague, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Romy van Weelderen
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jacqueline Cloos
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonas Abrahamsson
- Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Yves Bertrand
- Children's Leukemia Cooperative Group/European Organisation for Research and Treatment of Cancer, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Alcira Fynn
- Grupo Argentino de Tratamiento de la Leucemia Aguda, Children's Hospital La Plata, La Plata, Buenos Aires, Argentina
| | - Brenda Gibson
- Department of Paediatric Haematology, United Kingdom Childhood Leukaemia Study Group, Royal Hospital for Children, Glasgow, UK
| | - Shau-Yin Ha
- Department of Pediatrics/Pediatric oncology, Hong Kong Children's Hospital, Hong Kong, China
| | - Christine J Harrison
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Sarah Elitzur
- Schneider Children's Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Leverger
- Hematopathology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Alexei Maschan
- Oncology and Immunology, Dmitriy Rogachev Federal Center for Pediatric Hematology, Moscow, Russia
| | - Bassem Razzouk
- Children's Center for Cancer and Blood Diseases, Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana, USA
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University Hospital Essen, Essen, Germany
| | - Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Pter Smisek
- Department of Pediatric Hematology and Oncology, Carles University in Prague/Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Ursula Creutzig
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Gertjan J L Kaspers
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Clinical laboratory, Dutch Childhood Oncology Group, The Hague, The Netherlands.,Department of Pediatric Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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14
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Bertrums EJM, Zwaan CM, Hasegawa D, De Haas V, Reinhardt DN, Locatelli F, De Moerloose B, Dworzak M, Buijs A, Smisek P, Kolenova A, Pronk CJ, Klusmann JH, Carboné A, Ferster A, Antoniou E, Meshinchi S, Raimondi SC, Niemeyer CM, Hasle H, Van den Heuvel-Eibrink MM, Goemans BF. Guideline for management of non-Down syndrome neonates with a myeloproliferative disease on behalf of the I-BFM AML Study Group and EWOG-MDS. Haematologica 2021; 107:759-764. [PMID: 34854279 PMCID: PMC8883540 DOI: 10.3324/haematol.2021.279507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/24/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Eline J M Bertrums
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Erasmus MC, Rotterdam, the Netherlands; Oncode Institute, Utrecht.
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Erasmus MC, Rotterdam
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's international Hospital, Tokyo
| | - Valerie De Haas
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Dutch Childhood Oncology Group (DCOG), Utrecht
| | - Dirk N Reinhardt
- Department of Pediatric Oncology, University of Duisburg-Essen, Essen
| | - Franco Locatelli
- Sapienza, University of Rome Department of Pediatric Hematology-Oncology, IRCCS Bambino Gesù Children's Hospital, Rome
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent
| | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Kinderspital, Department of Pediatrics, Medical University of Vienna, Vienna
| | - Arjan Buijs
- Department of Genetics, University Medical Center, Utrecht
| | - Petr Smisek
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague
| | - Alexandra Kolenova
- Department of Pediatric Hematology and Oncology, Comenius University Children's Hospital, Bratislava
| | | | - Jan-Henning Klusmann
- Pediatric Hematology, Oncology and Hemostaseology, Hospital for Children and Adolescents, University Hospital of Frankfurt/Main, Goethe-University Frankfurt/Main, Frankfurt
| | - Ana Carboné
- Department of Pediatric Onco-Hematology, University Hospital Miguel Servet, Zaragoza
| | - Alina Ferster
- Department of Hemato-Oncology, Immunology and Transplantation, University Pediatric Hospital Reine Fabiola (ULB), Brussels
| | | | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | | | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus
| | | | - Bianca F Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Dutch Childhood Oncology Group (DCOG), Utrecht
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15
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Sahoo SS, Pastor VB, Goodings C, Voss RK, Kozyra EJ, Szvetnik A, Noellke P, Dworzak M, Starý J, Locatelli F, Masetti R, Schmugge M, De Moerloose B, Catala A, Kállay K, Turkiewicz D, Hasle H, Buechner J, Jahnukainen K, Ussowicz M, Polychronopoulou S, Smith OP, Fabri O, Barzilai S, de Haas V, Baumann I, Schwarz-Furlan S, Niewisch MR, Sauer MG, Burkhardt B, Lang P, Bader P, Beier R, Müller I, Albert MH, Meisel R, Schulz A, Cario G, Panda PK, Wehrle J, Hirabayashi S, Derecka M, Durruthy-Durruthy R, Göhring G, Yoshimi-Noellke A, Ku M, Lebrecht D, Erlacher M, Flotho C, Strahm B, Niemeyer CM, Wlodarski MW. Publisher Correction: Clinical evolution, genetic landscape and trajectories of clonal hematopoiesis in SAMD9/SAMD9L syndromes. Nat Med 2021; 27:2248. [PMID: 34799732 DOI: 10.1038/s41591-021-01632-y] [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] [Indexed: 11/09/2022]
Affiliation(s)
- Sushree S Sahoo
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Victor B Pastor
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charnise Goodings
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca K Voss
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emilia J Kozyra
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Amina Szvetnik
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Noellke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Jan Starý
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Sapienza University of Rome, Rome, Italy
| | - Riccardo Masetti
- Paediatric Oncology and Haematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children's Hospital, Zurich, Switzerland
| | - Barbara De Moerloose
- Department of Paediatric Haematology-Oncology, Ghent University Hospital Ghent, Ghent, Belgium
| | - Albert Catala
- Department of Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Krisztián Kállay
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Dominik Turkiewicz
- Department of Pediatric Oncology/Hematology, Skåne University Hospital, Lund, Sweden
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and SCT Children's Hospital, University of Helsinki and Helsinki University Hospital, Hus, Finland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology/Oncology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Owen P Smith
- Department of Pediatric Haematology/Oncology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Oksana Fabri
- Department. of Haematology and Transfusiology, National Institute of Children's Diseases Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Shlomit Barzilai
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valerie de Haas
- Dutch Childhood Oncology Group, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Irith Baumann
- Institute of Pathology, Klinikum Kaufbeuren-Ravensburg, Kaufbeuren, Germany
| | - Stephan Schwarz-Furlan
- Institute of Pathology, Klinikum Kaufbeuren-Ravensburg, Kaufbeuren, Germany.,Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | | | - Marena R Niewisch
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin G Sauer
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Peter Lang
- Department of Hematology/Oncology and General Pediatrics, Children's University Hospital, University of Tübingen, Tübingen, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Rita Beier
- University Hospital Essen, Pediatric Haematology and Oncology, Essen, Germany
| | - Ingo Müller
- Division of Pediatric Hematology and Oncology, Clinic of Pedatric Hematology and Oncology, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children´s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Division of Pediatric Stem Cell Therapy, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Gunnar Cario
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Pritam K Panda
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Digitalization in Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shinsuke Hirabayashi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marta Derecka
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Ayami Yoshimi-Noellke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manching Ku
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Lebrecht
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Erlacher
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Heidelberg and Freiburg, Germany
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Heidelberg and Freiburg, Germany
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Heidelberg and Freiburg, Germany
| | - Marcin W Wlodarski
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA. .,Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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16
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Cicconi L, Testi AM, Montesinos P, Rego E, Zhu HH, Takahashi H, Dworzak M, Estey E, Schwarer A, Esteve J, Annibali O, Castelli R, Mirabile M, Angelini M, Lazarevic V, Kumar J, Avvisati G, Gurnari C, Locatelli F, Voso MT, Sanz MA, Lo-Coco F, Abla O. Characteristics and outcome of acute myeloid leukemia with uncommon retinoic acid receptor-alpha (RARA) fusion variants. Blood Cancer J 2021; 11:167. [PMID: 34657125 PMCID: PMC8520532 DOI: 10.1038/s41408-021-00561-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Laura Cicconi
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy. .,UOSD Ematologia, ASL Roma 1, Rome, Italy.
| | - Anna Maria Testi
- Department of Translational and Precision Medicine and Hematology, 'Sapienza' University, Rome, Italy
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnico la Fe, València, Spain
| | - Eduardo Rego
- Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Hong Hu Zhu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | | | - Michael Dworzak
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Elihu Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anthony Schwarer
- Department of Hematology and Oncology, Eastern School, Monash University, Melbourne, VIC, Australia
| | - Jordi Esteve
- Servicio de Hematología, Instituto Clínic de Enfermedades Hematológicas y Oncológicas, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ombretta Annibali
- Hematology and Stem Cells Transplantation Unit, University Campus Bio-Medico, Rome, Italy
| | - Roberto Castelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milano, Italy
| | - Milena Mirabile
- HematologyUnit, Ospedale di Civitanova Marche, Macerata, Italy
| | | | - Vladimir Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jeevan Kumar
- Department of Clinical Haematology and BMT Tata Medical Center, Kolkata, India
| | - Giuseppe Avvisati
- Hematology and Stem Cells Transplantation Unit, University Campus Bio-Medico, Rome, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, IRCCS Ospedale Pediatrico Bambino Gesu, Rome, Italy.,Department of Pediatrics, Sapienza, University of Rome, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Miguel Angel Sanz
- Department of Hematology, Hospital Universitari i Politècnico la Fe, València, Spain
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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17
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Füreder A, Kropshofer G, Benesch M, Dworzak M, Greil S, Huber W, Hubmann H, Lawitschka A, Mann G, Michel‐Behnke I, Müller‐Sacherer T, Pichler H, Simonitsch‐Klupp I, Schwinger W, Szepfalusi Z, Crazzolara R, Attarbaschi A. Characteristics, management, and outcome of pediatric patients with post-transplant lymphoproliferative disease-A 20 years' experience from Austria. Cancer Rep (Hoboken) 2021; 4:e1375. [PMID: 33755341 PMCID: PMC8551996 DOI: 10.1002/cnr2.1375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/14/2020] [Revised: 03/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Management of pediatric post-transplantation lymphoproliferative disorder (PTLD) after hematopoietic stem cell (HSCT) and solid organ transplantation (SOT) is challenging. AIM This study of 34 PTLD patients up to 19-years old diagnosed in Austria from 2000 to 2018 aimed at assessing initial characteristics, therapy, response, and outcome as well as prognostic markers of this rare pediatric disease. METHODS AND RESULTS A retrospective data analysis was performed. Types of allografts were kidney (n = 12), liver (n = 7), heart (n = 5), hematopoietic stem cells (n = 4), lungs (n = 2), multi-visceral (n = 2), small intestine (n = 1), and vessels (n = 1). Eighteen/34 were classified as monomorphic PTLD, with DLBCL accounting for 15 cases. Polymorphic disease occurred in nine, and non-destructive lesions in six cases. One patient had a non-classifiable PTLD. Thirteen/34 patients are surviving event-free in first remission (non-destructive, n = 4/6; polymorphic, n = 4/9; monomorphic, n = 6/18). Fourteen/34 patients lacked complete response to first-line therapy, of whom seven died. Four/34 patients relapsed, of whom two died. In 3/34 patients, death occurred as a first event. The 5-year overall and event-free survival rates were 64% ± 9% and 35% ± 9% for the whole cohort. Among all parameters analyzed, only malignant disease as the indication for transplantation had a significantly poor influence on survival. CONCLUSIONS This study shows PTLD still to be a major cause of mortality following SOT or HSCT in children. A continued understanding of the molecular biology of the disease shall allow to decrease treatment intensity for lower risk patients and to identify patients who may benefit from newer therapy approaches to improve outcome and decrease morbidity.
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Affiliation(s)
- Anna Füreder
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Gabriele Kropshofer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of InnsbruckInnsbruckAustria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Michael Dworzak
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Sabine Greil
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart CenterMedical University of ViennaViennaAustria
| | - Wolf‐Dietrich Huber
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Holger Hubmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Anita Lawitschka
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Georg Mann
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
| | - Ina Michel‐Behnke
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart CenterMedical University of ViennaViennaAustria
| | - Thomas Müller‐Sacherer
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Herbert Pichler
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | | | - Wolfgang Schwinger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Zsolt Szepfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center PediatricsMedical University of ViennaViennaAustria
| | - Roman Crazzolara
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of InnsbruckInnsbruckAustria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
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18
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Sahoo SS, Pastor VB, Goodings C, Voss RK, Kozyra EJ, Szvetnik A, Noellke P, Dworzak M, Stary J, Locatelli F, Masetti R, Schmugge M, De Moerloose B, Catala A, Kállay K, Turkiewicz D, Hasle H, Buechner J, Jahnukainen K, Ussowicz M, Polychronopoulou S, Smith OP, Fabri O, Barzilai S, de Haas V, Baumann I, Schwarz-Furlan S, Niewisch MR, Sauer MG, Burkhardt B, Lang P, Bader P, Beier R, Müller I, Albert MH, Meisel R, Schulz A, Cario G, Panda PK, Wehrle J, Hirabayashi S, Derecka M, Durruthy-Durruthy R, Göhring G, Yoshimi-Noellke A, Ku M, Lebrecht D, Erlacher M, Flotho C, Strahm B, Niemeyer CM, Wlodarski MW. Clinical evolution, genetic landscape and trajectories of clonal hematopoiesis in SAMD9/SAMD9L syndromes. Nat Med 2021; 27:1806-1817. [PMID: 34621053 PMCID: PMC9330547 DOI: 10.1038/s41591-021-01511-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 09/24/2020] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
Germline SAMD9 and SAMD9L mutations (SAMD9/9Lmut) predispose to myelodysplastic syndromes (MDS) with propensity for somatic rescue. In this study, we investigated a clinically annotated pediatric MDS cohort (n = 669) to define the prevalence, genetic landscape, phenotype, therapy outcome and clonal architecture of SAMD9/9L syndromes. In consecutively diagnosed MDS, germline SAMD9/9Lmut accounted for 8% and were mutually exclusive with GATA2 mutations present in 7% of the cohort. Among SAMD9/9Lmut cases, refractory cytopenia was the most prevalent MDS subtype (90%); acquired monosomy 7 was present in 38%; constitutional abnormalities were noted in 57%; and immune dysfunction was present in 28%. The clinical outcome was independent of germline mutations. In total, 67 patients had 58 distinct germline SAMD9/9Lmut clustering to protein middle regions. Despite inconclusive in silico prediction, 94% of SAMD9/9Lmut suppressed HEK293 cell growth, and mutations expressed in CD34+ cells induced overt cell death. Furthermore, we found that 61% of SAMD9/9Lmut patients underwent somatic genetic rescue (SGR) resulting in clonal hematopoiesis, of which 95% was maladaptive (monosomy 7 ± cancer mutations), and 51% had adaptive nature (revertant UPD7q, somatic SAMD9/9Lmut). Finally, bone marrow single-cell DNA sequencing revealed multiple competing SGR events in individual patients. Our findings demonstrate that SGR is common in SAMD9/9Lmut MDS and exemplify the exceptional plasticity of hematopoiesis in children.
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Affiliation(s)
- Sushree S Sahoo
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, USA, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Victor B Pastor
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charnise Goodings
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Rebecca K Voss
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emilia J Kozyra
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Amina Szvetnik
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Noellke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children’s Hospital and Children’s Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Jan Stary
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù; Sapienza University of Rome, Italy
| | - Riccardo Masetti
- Paediatric Oncology and Haematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children’s Hospital, Zurich, Switzerland
| | - Barbara De Moerloose
- Department of Paediatric Haematology-Oncology, Ghent University Hospital Ghent, Belgium
| | - Albert Catala
- Department of Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Krisztián Kállay
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Dominik Turkiewicz
- Department of Pediatric Oncology/Hematology, Skåne University Hospital, Lund, Sweden
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and SCT Children′s Hospital, University of Helsinki and Helsinki University Hospital, Hus, Finland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, BMT Unit CIC 817, Wroclaw Medical University, Wroclaw, Poland
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology/Oncology, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Owen P Smith
- Department of Pediatric Haematology/Oncology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Oksana Fabri
- Department. of Haematology and Transfusiology, National Institute of Children’s Diseases Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Shlomit Barzilai
- Pediatric Hematology Oncology, Schneider Children’s Medical Center of Israel, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Valerie de Haas
- Dutch Childhood Oncology Group, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Irith Baumann
- Institute of Pathology, Klinikum Kaufbeuren-Ravensburg, Kaufbeuren, Germany
| | - Stephan Schwarz-Furlan
- Institute of Pathology, Klinikum Kaufbeuren-Ravensburg, Kaufbeuren, Germany, Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | | | - Marena R Niewisch
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin G Sauer
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Peter Lang
- Department of Hematology/Oncology and General Pediatrics, Children’s University Hospital, University of Tübingen, Tübingen, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Rita Beier
- University Hospital Essen, Pediatric Haematology and Oncology, Essen, Germany
| | - Ingo Müller
- Division of Pediatric Hematology and Oncology, Clinic of Pedatric Hematology and Oncology, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children′s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Division of Pediatric Stem Cell Therapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Gunnar Cario
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Pritam K Panda
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Institute of Digitalization in Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shinsuke Hirabayashi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marta Derecka
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Ayami Yoshimi-Noellke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manching Ku
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Lebrecht
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Erlacher
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany, German Cancer Consortium (DKTK), Heidelberg and Freiburg, Germany
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany, German Cancer Consortium (DKTK), Heidelberg and Freiburg, Germany
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany, German Cancer Consortium (DKTK), Heidelberg and Freiburg, Germany
| | - Marcin W Wlodarski
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, USA, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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19
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Sahoo S, Pastor V, Goodings C, Noellke P, Dworzak M, Stary J, Locatelli F, Masetti R, Schmugge M, De Moerloose B, Catala A, Kállay K, Turkiewicz D, Hasle H, Buechner J, Jahnukainen K, Ussowicz M, Polychronopoulou S, Smith O, Fabri O, Barzilai S, De Haas V, Baumann I, Schwarz-Furlan S, Göhring G, Yoshimi A, Flotho C, Strahm B, Erlacher M, Niemeyer C, Wlodarski M. Topic: AS04-MDS Biology and Pathogenesis/AS04b-Clonal diversity & evolution. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106679.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Yoshimi A, Vinci L, Flotho C, Noellke P, Erlacher M, Lebrecht D, Masetti R, De Haas V, De Moerloose B, Dworzak M, Hasle H, Schmugge M, Stary J, Turkiewicz D, Ussowicz M, Catala A, Buechner J, Jahnukainen K, Kállay K, Fabri O, Smith O, Göhring G, Locatelli F, Strahm B, Niemeyer C. Topic: AS06-Prognosis/AS06b-Predictive factors of response to treatment. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106680.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Al-Kershi S, Golnik R, Flasinski M, Waack K, Rasche M, Creutzig U, Dworzak M, Reinhardt D, Klusmann JH. Recommendations for Diagnosis and Treatment of Children with Transient Abnormal Myelopoiesis (TAM) and Myeloid Leukemia in Down Syndrome (ML-DS). Klin Padiatr 2021; 233:267-277. [PMID: 34407551 DOI: 10.1055/a-1532-2016] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Children with Down syndrome are at a high risk of developing transient abnormal myelopoiesis (TAM; synonym: TMD) or myeloid leukemia (ML-DS). While most patients with TAM are asymptomatic and go into spontaneous remission without a need for therapy, around 20% of patients die within the first six months due to TAM-related complications. Another 20-30% of patients progress from TAM to ML-DS. ML-DS patients are particularly vulnerable to therapy-associated toxicity, but the prognosis of relapsed ML-DS is extremely poor - thus, ML-DS therapy schemata must strive for a balance between appropriate efficacy (to avoid relapses) and treatment-related toxicity. This guideline presents diagnostic and therapeutic strategies for TAM and ML-DS based on the experience and results of previous clinical studies from the BFM working group, which have helped reduce the risk of early death in symptomatic TAM patients using low-dose cytarabine, and which have achieved excellent cure rates for ML-DS using intensity-reduced treatment protocols.
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Affiliation(s)
- Sina Al-Kershi
- Clinic for Pediatrics, University Hospital Frankfurt, Frankfurt, Germany.,Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Golnik
- Clinic for Pediatrics, University Hospital Frankfurt, Frankfurt, Germany
| | - Marius Flasinski
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Hospital Tauberbischofsheim, Tauberbischofsheim, Germany
| | - Katharina Waack
- Pediatrics III, Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Mareike Rasche
- Pediatrics III, Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Ursula Creutzig
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Wien, Austria
| | - Dirk Reinhardt
- Pediatrics III, Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
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22
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Bortnick R, Wlodarski M, de Haas V, De Moerloose B, Dworzak M, Hasle H, Masetti R, Starý J, Turkiewicz D, Ussowicz M, Kozyra E, Albert M, Bader P, Bordon V, Cario G, Beier R, Schulte J, Bresters D, Müller I, Pichler H, Sedlacek P, Sauer MG, Zecca M, Göhring G, Yoshimi A, Noellke P, Erlacher M, Locatelli F, Niemeyer CM, Strahm B. Hematopoietic stem cell transplantation in children and adolescents with GATA2-related myelodysplastic syndrome. Bone Marrow Transplant 2021; 56:2732-2741. [PMID: 34244664 PMCID: PMC8563415 DOI: 10.1038/s41409-021-01374-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/05/2021] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 01/08/2023]
Abstract
GATA2 deficiency is a heterogeneous multi-system disorder characterized by a high risk of developing myelodysplastic syndrome (MDS) and myeloid leukemia. We analyzed the outcome of 65 patients reported to the registry of the European Working Group (EWOG) of MDS in childhood carrying a germline GATA2 mutation (GATA2mut) who had undergone hematopoietic stem cell transplantation (HSCT). At 5 years the probability of overall survival and disease-free survival (DFS) was 75% and 70%, respectively. Non-relapse mortality and relapse equally contributed to treatment failure. There was no evidence of increased incidence of graft-versus-host-disease or excessive rates of infections or organ toxicities. Advanced disease and monosomy 7 (-7) were associated with worse outcome. Patients with refractory cytopenia of childhood (RCC) and normal karyotype showed an excellent outcome (DFS 90%) compared to RCC and -7 (DFS 67%). Comparing outcome of GATA2mut with GATA2wt patients, there was no difference in DFS in patients with RCC and normal karyotype. The same was true for patients with -7 across morphological subtypes. We demonstrate that HSCT outcome is independent of GATA2 germline mutations in pediatric MDS suggesting the application of standard MDS algorithms and protocols. Our data support considering HSCT early in the course of GATA2 deficiency in young individuals.
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Affiliation(s)
- Rachel Bortnick
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Marcin Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie de Haas
- Princess Maxima Center, Diagnostic Laboratory/DCOG Laboratory, Utrecht, The Netherlands
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Riccardo Masetti
- Department of Pediatric Oncology and Hematology, University of Bologna, Bologna, Italy
| | - Jan Starý
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Dominik Turkiewicz
- Department of Pediatric Oncology/Hematology, Skåne University Hospital, Lund, Sweden
| | - Marek Ussowicz
- Department of Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Emilia Kozyra
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Frankfurt, Germany
| | - Victoria Bordon
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Gunnar Cario
- Department of Pediatrics, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Rita Beier
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Hospital of Essen, Essen, Germany
| | - Johannes Schulte
- Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ingo Müller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Pichler
- Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin G Sauer
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Ayami Yoshimi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Noellke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Erlacher
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Heidelberg and Freiburg, Freiburg, Germany
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Sapienza, University of Rome, Rome, Italy
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Heidelberg and Freiburg, Freiburg, Germany
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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23
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Obrová K, Grumaz S, Remely M, Czurda S, Krickl I, Herndlhofer S, Gleixner KV, Sperr WR, Größlinger L, Frank T, Andrade N, Egger‐Matiqi T, Peters C, Engstler G, Dworzak M, Attarbaschi A, Grotel M, Heuvel‐Eibrink MM, Moiseev IS, Rogacheva Y, Zubarovskaya L, Zubarovskaya N, Pichler H, Lawitschka A, Koller E, Keil F, Valent P, Sohn K, Lion T. Presence of viremia during febrile neutropenic episodes in patients undergoing chemotherapy for malignant neoplasms. Am J Hematol 2021; 96:719-726. [PMID: 33784434 DOI: 10.1002/ajh.26177] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
The importance of viral infections as a leading cause of morbidity and mortality is well documented in severely immunosuppressed patients undergoing allogeneic stem cell transplantation. By contrast, viral infections generally receive less attention in patients with malignant disorders undergoing chemotherapy, where the onset of neutropenic fever is mostly associated with bacterial or fungal infections, and screening for viral infections is not routinely performed. To address the occurrence of invasive viral infections in a clinical setting commonly associated with less pronounced immunosuppression, we have prospectively screened 237 febrile neutropenic episodes in pediatric (n = 77) and adult (n = 69) patients undergoing intensive chemotherapy, primarily for treatment of acute leukemia. Serial peripheral blood specimens were tested by RQ-PCR assays for the presence and quantity of the clinically relevant viruses CMV, EBV, HHV6 and HAdV, commonly reactivated in highly immunocompromised patients. Viremia was documented in 36 (15%) episodes investigated, including the detection of HHV6 (n = 14), EBV (n = 15), CMV (n = 6), or HAdV (n = 1). While low or intermediate levels of viremia (<104 virus copies/mL) were commonly associated with bacterial or fungal co-infection, viremia at higher levels (>104 copies/mL) was documented in patients without evidence for other infections, raising the possibility that at least in some instances the onset of fever may have been attributable to the virus detected. The observations suggest that viral infections, potentially resulting from reactivation, might also play a clinically relevant role in patients receiving chemotherapy for treatment of malignant neoplasms, and routine screening for viremia in this clinical setting might be warranted.
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Affiliation(s)
- Klára Obrová
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | | | - Marlene Remely
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Stefan Czurda
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Isabella Krickl
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Susanne Herndlhofer
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
| | - Karoline V. Gleixner
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
| | - Wolfgang R. Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
| | | | - Tijana Frank
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Nuno Andrade
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Teresa Egger‐Matiqi
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Christina Peters
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Gernot Engstler
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Michael Dworzak
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Andishe Attarbaschi
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Martine Grotel
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Ivan S. Moiseev
- I. P. Pavlov First Saint Petersburg State Medical University Saint Petersburg Russia
| | - Yuliya Rogacheva
- I. P. Pavlov First Saint Petersburg State Medical University Saint Petersburg Russia
| | - Ludmilla Zubarovskaya
- I. P. Pavlov First Saint Petersburg State Medical University Saint Petersburg Russia
| | - Natalia Zubarovskaya
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Herbert Pichler
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Anita Lawitschka
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | | | - Felix Keil
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
- 3rd Medical Department Hanuschhospital Vienna Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
| | - Kai Sohn
- Fraunhofer IGB Stuttgart Germany
| | - Thomas Lion
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
- Labdia Labordiagnostik GmbH Vienna Austria
- Department of Pediatrics Medical University of Vienna Vienna Austria
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24
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Peneder P, Stütz AM, Surdez D, Krumbholz M, Semper S, Chicard M, Sheffield NC, Pierron G, Lapouble E, Tötzl M, Ergüner B, Barreca D, Rendeiro AF, Agaimy A, Boztug H, Engstler G, Dworzak M, Bernkopf M, Taschner-Mandl S, Ambros IM, Myklebost O, Marec-Bérard P, Burchill SA, Brennan B, Strauss SJ, Whelan J, Schleiermacher G, Schaefer C, Dirksen U, Hutter C, Boye K, Ambros PF, Delattre O, Metzler M, Bock C, Tomazou EM. Multimodal analysis of cell-free DNA whole-genome sequencing for pediatric cancers with low mutational burden. Nat Commun 2021; 12:3230. [PMID: 34050156 PMCID: PMC8163828 DOI: 10.1038/s41467-021-23445-w] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
Sequencing of cell-free DNA in the blood of cancer patients (liquid biopsy) provides attractive opportunities for early diagnosis, assessment of treatment response, and minimally invasive disease monitoring. To unlock liquid biopsy analysis for pediatric tumors with few genetic aberrations, we introduce an integrated genetic/epigenetic analysis method and demonstrate its utility on 241 deep whole-genome sequencing profiles of 95 patients with Ewing sarcoma and 31 patients with other pediatric sarcomas. Our method achieves sensitive detection and classification of circulating tumor DNA in peripheral blood independent of any genetic alterations. Moreover, we benchmark different metrics for cell-free DNA fragmentation analysis, and we introduce the LIQUORICE algorithm for detecting circulating tumor DNA based on cancer-specific chromatin signatures. Finally, we combine several fragmentation-based metrics into an integrated machine learning classifier for liquid biopsy analysis that exploits widespread epigenetic deregulation and is tailored to cancers with low mutation rates. Clinical associations highlight the potential value of cfDNA fragmentation patterns as prognostic biomarkers in Ewing sarcoma. In summary, our study provides a comprehensive analysis of circulating tumor DNA beyond recurrent genetic aberrations, and it renders the benefits of liquid biopsy more readily accessible for childhood cancers.
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Affiliation(s)
- Peter Peneder
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Adrian M Stütz
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Didier Surdez
- INSERM U830, Équipe Labellisée LNCC, PSL Research University, SIREDO Oncology Centre, Institut Curie Research Centre, Paris, France
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Manuela Krumbholz
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Sabine Semper
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Mathieu Chicard
- INSERM U830, Équipe Labellisée LNCC, PSL Research University, SIREDO Oncology Centre, Institut Curie Research Centre, Paris, France
| | - Nathan C Sheffield
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Gaelle Pierron
- Unité de Génétique Somatique, Service d'oncogénétique, Institut Curie, Centre Hospitalier, Paris, France
| | - Eve Lapouble
- Unité de Génétique Somatique, Service d'oncogénétique, Institut Curie, Centre Hospitalier, Paris, France
| | - Marcus Tötzl
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Bekir Ergüner
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Daniele Barreca
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - André F Rendeiro
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Heidrun Boztug
- St. Anna Kinderspital, Department of Pediatrics, Medical University, Vienna, Austria
| | - Gernot Engstler
- St. Anna Kinderspital, Department of Pediatrics, Medical University, Vienna, Austria
| | - Michael Dworzak
- St. Anna Kinderspital, Department of Pediatrics, Medical University, Vienna, Austria
| | - Marie Bernkopf
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | | | - Inge M Ambros
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Ola Myklebost
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Perrine Marec-Bérard
- Pediatric Department, Hematology and Oncology Pediatric Institute, Centre Léon Bérard, Lyon, France
| | - Susan Ann Burchill
- Children's Cancer Research Group, Leeds Institute of Medical Research, St. James's University Hospital, Leeds, UK
| | - Bernadette Brennan
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Sandra J Strauss
- Department of Oncology, UCL Cancer Institute, London, UK
- Department of Oncology, University College London Hospital, London, UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospital, London, UK
| | - Gudrun Schleiermacher
- INSERM U830, Équipe Labellisée LNCC, PSL Research University, SIREDO Oncology Centre, Institut Curie Research Centre, Paris, France
| | - Christiane Schaefer
- University Hospital Essen, Pediatrics III, West German Cancer Centre, Essen, Germany
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, Essen, Germany
| | - Caroline Hutter
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- St. Anna Kinderspital, Department of Pediatrics, Medical University, Vienna, Austria
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Peter F Ambros
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Olivier Delattre
- INSERM U830, Équipe Labellisée LNCC, PSL Research University, SIREDO Oncology Centre, Institut Curie Research Centre, Paris, France
- Unité de Génétique Somatique, Service d'oncogénétique, Institut Curie, Centre Hospitalier, Paris, France
| | - Markus Metzler
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.
- Institute of Artificial Intelligence, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.
| | - Eleni M Tomazou
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria.
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25
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Meral Günes A, Millot F, Kalwak K, Lausen B, Sedlacek P, Versluys AB, Dworzak M, De Moerloose B, Suttorp M. Features and outcome of chronic myeloid leukemia at very young age: Data from the International Pediatric Chronic Myeloid Leukemia Registry. Pediatr Blood Cancer 2021; 68:e28706. [PMID: 33034135 DOI: 10.1002/pbc.28706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is rare in the first two decades of life comprising only 3% of newly diagnosed pediatric and adolescent leukemias. We studied the epidemiologic and clinical features of patients with CML diagnosed at younger than 3 years of age and evaluated treatment and long-term outcome. METHOD Data from the International Pediatric I-BFM/CML Registry were retrospectively analyzed using the European LeukemiaNet criteria of the year 2006. Characteristics and treatment outcome of patients <3 years old at diagnosis were evaluated from standardized forms. RESULTS Twenty-two patients (n = 22/479; 4.6%, male/female:14/8) were enrolled with a median age of 22 months (range, 10-34 m). Major symptoms comprised asthenia (30%), fever (30%), abdominal pain (20%), extramedullary signs (14%), hemorrhage (5%), and weight loss (5%). The extramedullary signs were specified in eight children: blueberry muffin (n = 1), sudden swollen abdomen (n = 1), sustained vomiting (n = 1), and cervical and inguinal lymph nodes (n = 5). Two of five children with cervical and inguinal lymph nodes were categorized as accelerated phase. Overall, 19 of 22 (86%) children were diagnosed in chronic phase, while the remaining three patients were in advanced phase. Median follow-up was 78 months (range, 7-196 m). Twenty-one out of 22 patients initially received imatinib, while one child received IFN + ARA-C. Imatinib was changed to second-line tyrosine kinase inhibitors (TKIs) in 29% of cases. During follow-up, 41% patients underwent stem cell transplantation (SCT). While on TKI, major molecular response (MMR) was achieved in 48% of children. Among the remaining patients, 21% are alive on TKI without MMR and 22% achieved complete molecular response following SCT. Twenty-one of 22 (95%) children are alive, while one patient died of posttransplant complications. CONCLUSION This report demonstrates for the first time the efficacy and long-term effects of upfront imatinib in the so far largest cohort of children with CML diagnosed at very young age.
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Affiliation(s)
- Adalet Meral Günes
- Department of Pediatric Hematology, Medical Faculty, Uludag University, Nilüfer, Bursa, Turkey
| | - Frédéric Millot
- Pediatric Oncology Unit, University Hospital, Poitiers, France
| | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Birgitte Lausen
- Department of Pediatric and Adolescent Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - A Birgitta Versluys
- Department of Blood and Marrow Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Pediatric Clinic, Medical University of Vienna, Vienna, Austria
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Meinolf Suttorp
- Medical Faculty, Pediatric Hematology-Oncology, Technical University of Dresden, Dresden, Germany
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26
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Kozyra EJ, Pastor VB, Lefkopoulos S, Sahoo SS, Busch H, Voss RK, Erlacher M, Lebrecht D, Szvetnik EA, Hirabayashi S, Pasaulienė R, Pedace L, Tartaglia M, Klemann C, Metzger P, Boerries M, Catala A, Hasle H, de Haas V, Kállay K, Masetti R, De Moerloose B, Dworzak M, Schmugge M, Smith O, Starý J, Mejstrikova E, Ussowicz M, Morris E, Singh P, Collin M, Derecka M, Göhring G, Flotho C, Strahm B, Locatelli F, Niemeyer CM, Trompouki E, Wlodarski MW. Synonymous GATA2 mutations result in selective loss of mutated RNA and are common in patients with GATA2 deficiency. Leukemia 2020; 34:2673-2687. [PMID: 32555368 PMCID: PMC7515837 DOI: 10.1038/s41375-020-0899-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 09/18/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 02/08/2023]
Abstract
Deficiency of the transcription factor GATA2 is a highly penetrant genetic disorder predisposing to myelodysplastic syndromes (MDS) and immunodeficiency. It has been recognized as the most common cause underlying primary MDS in children. Triggered by the discovery of a recurrent synonymous GATA2 variant, we systematically investigated 911 patients with phenotype of pediatric MDS or cellular deficiencies for the presence of synonymous alterations in GATA2. In total, we identified nine individuals with five heterozygous synonymous mutations: c.351C>G, p.T117T (N = 4); c.649C>T, p.L217L; c.981G>A, p.G327G; c.1023C>T, p.A341A; and c.1416G>A, p.P472P (N = 2). They accounted for 8.2% (9/110) of cases with GATA2 deficiency in our cohort and resulted in selective loss of mutant RNA. While for the hotspot mutation (c.351C>G) a splicing error leading to RNA and protein reduction was identified, severe, likely late stage RNA loss without splicing disruption was found for other mutations. Finally, the synonymous mutations did not alter protein function or stability. In summary, synonymous GATA2 substitutions are a new common cause of GATA2 deficiency. These findings have broad implications for genetic counseling and pathogenic variant discovery in Mendelian disorders.
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Affiliation(s)
- Emilia J Kozyra
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104, Freiburg, Germany
| | - Victor B Pastor
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stylianos Lefkopoulos
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104, Freiburg, Germany.,Department of Cellular and Molecular Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Sushree S Sahoo
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Hematology, St. Jude Children´s Research Hospital, Memphis, USA
| | - Hauke Busch
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany.,Lübeck Institute of Experimental Dermatology and Institute of Cardiogenetics, University of Lübeck, Lübeck, Germany.,Comprehensive Cancer Center Freiburg (CCCF), University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rebecca K Voss
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Erlacher
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk Lebrecht
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Enikoe A Szvetnik
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shinsuke Hirabayashi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ramunė Pasaulienė
- Vilnius University Hospital Santaros Klinikos, Center for Pediatric Oncology and Hematology, Bone Marrow Transplantations Unit, Vilnius, Lithuania
| | - Lucia Pedace
- Department of Pediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Christian Klemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Patrick Metzger
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104, Freiburg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albert Catala
- Department of Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Valerie de Haas
- Dutch Childhood Oncology Group (DCOG), Princess Máxima Centre, Utrecht, The Netherlands
| | - Krisztián Kállay
- Central Hospital of Southern Pest-National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Riccardo Masetti
- Department of Pediatric Oncology and Hematology, University of Bologna, Bologna, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael Dworzak
- St. Anna Children´s Hospital and Cancer Research Institute, Pediatric Clinic, Medical University of Vienna, Vienna, Austria
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children's Hospital, Zurich, Switzerland
| | - Owen Smith
- Paediatric Oncology and Haematology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Jan Starý
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ester Mejstrikova
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Medical University of Wroclaw, Wroclaw, Poland
| | - Emma Morris
- Institute of Immunity and Transplantation, University College London (UCL), London, UK.,Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, UK.,Department of Immunology, Royal Free London NHS FT, London, UK
| | - Preeti Singh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Matthew Collin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marta Derecka
- Department of Cellular and Molecular Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Gudrun Göhring
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Brigitte Strahm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy.,Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eirini Trompouki
- Department of Cellular and Molecular Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany.,CIBSS-Centre for Integrative Biological Signaling Studies, Freiburg, Germany
| | - Marcin W Wlodarski
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Department of Hematology, St. Jude Children´s Research Hospital, Memphis, USA.
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Perwein T, Lackner H, Ebetsberger-Dachs G, Beham-Schmid C, Zach K, Tamesberger M, Simonitsch-Klupp I, Lüftinger R, Dworzak M, Mann G, Benesch M, Attarbaschi A. Management of children and adolescents with gray zone lymphoma: A case series. Pediatr Blood Cancer 2020; 67:e28206. [PMID: 32037692 DOI: 10.1002/pbc.28206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/03/2020] [Accepted: 01/20/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data on management of gray zone lymphoma (GZL) in children and adolescents are scarce. PROCEDURE This retrospective study assessed clinical characteristics and outcome in six Austrian patients with GZL less than 18 years of age (male-to-female ratio: 1:1; median age: 15.8 years). RESULTS Two patients each had a classical Hodgkin lymphoma (cHL)-like and composite GZL subtype, and one patient each had a large B-cell non-Hodgkin lymphoma (LBCL)-like and sequential GZL subtype. All had advanced disease with mediastinal and extranodal involvement. Five patients received an LBCL- and one patient a cHL-directed polychemotherapy ± radiotherapy. Out of the former patients, three survived, including two who relapsed and underwent high-dose chemotherapy with autologous stem cell rescue. The latter patient survived. CONCLUSIONS GZL remains a diagnostic and therapeutic challenge, necessitating the development of novel treatment concepts performed in a prospective setting.
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Affiliation(s)
- Thomas Perwein
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herwig Lackner
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg Ebetsberger-Dachs
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | | | - Klara Zach
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Tamesberger
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | | | - Roswitha Lüftinger
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Dworzak
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Mann
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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28
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Doz F, Locatelli F, Baruchel A, Blin N, De Moerloose B, Frappaz D, Dworzak M, Fischer M, Stary J, Fuertig R, Riemann K, Taube T, Reinhardt D. Phase I dose-escalation study of volasertib in pediatric patients with acute leukemia or advanced solid tumors. Pediatr Blood Cancer 2019; 66:e27900. [PMID: 31276318 DOI: 10.1002/pbc.27900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Volasertib induces mitotic arrest and apoptosis by targeting Polo-like kinases. In this phase I dose-escalation study, the maximum tolerated dose (MTD), pharmacokinetics (PK), and preliminary efficacy of volasertib were determined in pediatric patients. METHODS Patients aged 2 to <18 years with relapsed/refractory acute leukemia/advanced solid tumors (ST) without available effective treatments were enrolled-cohort C1 (aged 2 to <12 years); cohort C2 (aged 12 to <18 years). The patients received volasertib intravenously (starting dose: 200 mg/m2 body surface area on day 1, every 14 days). The primary endpoint was the pediatric MTD for further development. RESULTS Twenty-two patients received treatment (C1: leukemia, n = 4; ST, n = 8; C2: leukemia, n = 3; ST, n = 7). No dose-limiting toxicities (DLTs) occurred up to 300 mg/m2 volasertib in C1; two patients in C2, at 250 mg/m2 volasertib, had DLTs in cycle 1, one of which led to death; therefore, the MTD of volasertib in C2 was 200 mg/m2 . The most common grade 3/4 adverse events (all patients) were febrile neutropenia, thrombocytopenia, and neutropenia (41% each). Stable disease (SD) was the best objective response (leukemia, n = 5; ST, n = 2); the duration of SD was short in all patients, except in one with an ST. PK profiles were generally comparable across dose groups and were consistent with those in adults. CONCLUSION The pediatric MTD/dose for further development was identified. There were no unexpected safety or PK findings; limited antitumor/antileukemic activity was demonstrated.
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Affiliation(s)
- François Doz
- Oncology Center SIREDO (Care Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institute Curie and University Paris Descartes, Paris, France
| | - Franco Locatelli
- Department of Paediatric Haematology and Oncology, IRCCS (Istituto di Recovero e Cura a Carattere Scientifico), Bambino Gesù Children's Hospital, Sapienza University of Rome, Rome, Italy
| | - André Baruchel
- Department of Paediatric Haemato-immunology, Hôpital Robert Debré (APHP), University Paris Diderot, Paris, France
| | - Nicolas Blin
- Paediatric Haematology and Oncology, Hôpital Mère-Enfant, CHU de Nantes, Nantes, France
| | - Barbara De Moerloose
- Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Didier Frappaz
- Paediatric Oncology Department, Léon Bérard Centre, Lyon, France
| | - Michael Dworzak
- St. Anna Children's Hospital, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Matthias Fischer
- Department of Experimental Paediatric Oncology, University Children's Hospital Cologne, Centre of Molecular Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jan Stary
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Rene Fuertig
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Kathrin Riemann
- Clinical Operations, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Tillmann Taube
- Medical Oncology, Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Dirk Reinhardt
- Department of Paediatrics, University Hospital Essen, Essen, Germany
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29
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Poyer F, Friesenbichler W, Hutter C, Pichler H, Dworzak M, Peters C, Mann G, Indra A, Attarbaschi A. Rothia mucilaginosa bacteremia: A 10-year experience of a pediatric tertiary care cancer center. Pediatr Blood Cancer 2019; 66:e27691. [PMID: 30825249 DOI: 10.1002/pbc.27691] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/10/2022]
Abstract
Rothia mucilaginosa is part of the oral and upper respiratory tract flora. Usually, this gram-positive coccus is not pathogenic; however, in the setting of immunosuppressed hosts, it can cause life-threatening infections as an opportunistic pathogen. Among a cohort of 1511 hematologic-oncologic patients at a pediatric tertiary care cancer center, we identified five cancer patients (0.35%) within a period of 10 years having a proven Rothia mucilaginosa bacteremia (1 culture positive: n = 3/5; > 1 culture positive: n = 2/5). With prompt and adequate antibiotic treatment, infection resolved rapidly before recovery of neutrophils and without any sequelae, suggesting that Rothia mucilaginosa bacteremia without organ involvement is not exceptionally problematic in pediatric cancer patients.
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Affiliation(s)
- Fiona Poyer
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Waltraud Friesenbichler
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Caroline Hutter
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Herbert Pichler
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Dworzak
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Christina Peters
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Mann
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Indra
- Institute for Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Andishe Attarbaschi
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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30
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Creutzig U, Dworzak M, von Neuhoff N, Rasche M, Reinhardt D. Akute Promyelozyten-Leukämie: Neue Behandlungsstrategien mit ATRA und ATO – AML-BFM-Empfehlungen. Klin Padiatr 2018; 230:299-304. [DOI: 10.1055/a-0750-5963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungDie Behandlung der Akuten Promyelozyten-Leukämie (APL) hat sich in den letzten Jahren deutlich geändert. Heute können APL Patienten mit Standardrisiko – (auch als Niedrigrisiko bezeichnet) ohne Chemotherapie nur mit all-trans-Retinsäure (ATRA) und Arsentrioxid (ATO) behandelt werden. Bei Hochrisikopatienten sollte eine Induktions-Chemotherapie hinzugefügt werden. Die kurativen Ergebnisse sind gut und vergleichbar mit jenen, die in der Vergangenheit mit Chemotherapie plus ATRA erzielt wurden. Toxizitäten, insbesondere infektiöse Komplikationen sind jedoch deutlich seltener. Das Hauptrisiko bleiben frühe letale Blutungen. Durch rechtzeitige Diagnose und frühe ATRA-Behandlung kann dieses Risiko reduziert werden. In der vorliegenden Übersicht werden die aktuellen Behandlungsstrategien und Empfehlungen für APL bei Kindern dargestellt und diskutiert.
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Affiliation(s)
- Ursula Creutzig
- Pediatric Hematology/Oncology, Hannover Medical School Hannover, Hannover
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute/Medical University of Vienna, Vienna, Austria
| | - Nils von Neuhoff
- Department of Pediatric Hematology-Oncology, Pediatrics III, University Hospital of Essen, Essen
| | - Mareike Rasche
- Department of Pediatric Hematology-Oncology, Pediatrics III, University Hospital of Essen, Essen
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, Pediatrics III, University Hospital of Essen, Essen
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31
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Niktoreh N, Lerius B, Zimmermann M, Gruhn B, Escherich G, Bourquin JP, Dworzak M, Sramkova L, Rossig C, Creutzig U, Reinhardt D, Rasche M. Gemtuzumab ozogamicin in children with relapsed or refractory acute myeloid leukemia: a report by Berlin-Frankfurt-Münster study group. Haematologica 2018; 104:120-127. [PMID: 30093401 PMCID: PMC6312035 DOI: 10.3324/haematol.2018.191841] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 02/23/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
Despite intensified salvage treatments, children with relapsed/refractory acute myeloid leukemia (AML) have poor survival. We evaluated gemtuzumab ozogamicin (CD33-targeted drug) used on a compassionate basis in patients diagnosed from 1995 until 2014 within Acute Myeloid Leukemia Berlin-Frankfurt-Münster studies, and identified 76 patients (<18 years) with highly-advanced and pre-treated AML [refractory de novo acute myeloid leukemia (n=10), de novo AML refractory to relapse (1st early: n=41; 1st late: n=10; 2nd or more: n=10), and secondary AML (n=5)]. At doses of 2.5–10 mg/m2, gemtuzumab ozogamicin was administered in 1-4 cycles as single agent (47%), combined with cytarabine (47%), or others (6%). Most common grade 3/4 adverse events were infections or febrile neutropenia (78% of severe adverse events), infusion-related immunological reactions (6%), and gastrointestinal symptoms (5%). Three patients experienced veno-occlusive disease (one fatal due to exacerbation of a pre-existing cardiomyopathy). Sixty-four percent received subsequent hematopoietic stem cell transplantation. Probability of 4-year overall survival was 18±5% in all, 27±7% in patients with and 0% in patients without hematopoietic stem cell transplantation (P<0.0001). Administration of gemtuzumab ozogamicin on a patient-specific, compassionate use basis was frequently considered in our study group and proved to be effective for bridging children with very advanced AML to hematopoietic stem cell transplantation. Uniform prospective studies for these patients are urgently needed.
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Affiliation(s)
- Naghmeh Niktoreh
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
| | - Beate Lerius
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, Eppendorf University Hospital, Hamburg, Germany
| | - Jean-Pierre Bourquin
- Division of Pediatric Hematology/Oncology, University Children's Hospital Zurich, Switzerland
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Austria
| | - Lucie Sramkova
- Department of Pediatric Hematology and Oncology, 2 Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Claudia Rossig
- University Children's Hospital Münster, Pediatric Hematology and Oncology, Germany
| | - Ursula Creutzig
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
| | - Mareike Rasche
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Germany
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32
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Kager L, Jimenez Heredia R, Hirschmugl T, Dmytrus J, Krolo A, Müller H, Bock C, Zeitlhofer P, Dworzak M, Mann G, Holter W, Haas O, Boztug K. Targeted mutation screening of 292 candidate genes in 38 children with inborn haematological cytopenias efficiently identifies novel disease-causing mutations. Br J Haematol 2018; 182:251-258. [PMID: 29797310 PMCID: PMC6079646 DOI: 10.1111/bjh.15389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/19/2018] [Indexed: 12/16/2022]
Abstract
Establishing a precise diagnosis is essential in inborn haematological cytopenias to enable appropriate treatment decisions and avoid secondary organ damage. However, both diversity and phenotypic overlap of distinct disease entities may make the identification of underlying genetic aetiologies by classical Sanger sequencing challenging. Instead of exome sequencing, we established a systematic next generation sequencing‐based panel targeting 292 candidate genes and screened 38 consecutive patients for disease‐associated mutations. Efficient identification of the underlying genetic cause in 17 patients (44·7%), including 13 novel mutations, demonstrates that this approach is time‐ and cost‐efficient, enabling optimal management and genetic counselling.
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Affiliation(s)
- Leo Kager
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria
| | | | - Tatjana Hirschmugl
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Jasmin Dmytrus
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Ana Krolo
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Heiko Müller
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Christoph Bock
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Centre for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | | | - Michael Dworzak
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria
| | - Georg Mann
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Holter
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Oskar Haas
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria.,medgen.at GmbH, Vienna, Austria
| | - Kaan Boztug
- St Anna Children's Hospital, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria.,Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Centre for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
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33
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Friesenbichler W, Krizmanich W, Lakatos K, Attarbaschi A, Dworzak M, Amann G, Furtwängler R, Graf N, Kager L. Outcome of two patients with bilateral nephroblastomatosis/Wilms tumour treated with an add-on 13-cis retinoic acid therapy - Case report. Pediatr Hematol Oncol 2018; 35:218-224. [PMID: 30260265 DOI: 10.1080/08880018.2018.1515284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although the fate of nephrogenic rests varies, they are known to be precursors of Wilms tumour. Thus, nephrogenic rests require adequate treatment to prevent malignant transformation. We added 13-cis retinoic acid to the standard chemotherapy with vincristine and actinomycin-D in two patients with bilateral nephrogenic rests/nephroblastomatosis. Patient 1 also had a history of Wilms tumour. 46 (patient 1) and 81 (patient 2) months after end of treatment, both patients show stable conditions with no signs of relapse or progressive disease. Our observation supports further investigation of retinoic acid in patients with nephrogenic rests and nephroblastomatosis.
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Affiliation(s)
- Waltraud Friesenbichler
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Wolfgang Krizmanich
- b Department of Radiology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Karoly Lakatos
- b Department of Radiology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Andishe Attarbaschi
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Michael Dworzak
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria.,c Children's Cancer Research Institute (CCRI) , Vienna , Austria
| | - Gabriele Amann
- d Institute of Pathology , Medical University of Vienna , Vienna , Austria
| | - Rhoikos Furtwängler
- e Department for Pediatric Hematology and Oncology , Saarland University , Homburg , Germany
| | - Norbert Graf
- e Department for Pediatric Hematology and Oncology , Saarland University , Homburg , Germany
| | - Leo Kager
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
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34
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Lipka DB, Witte T, Toth R, Yang J, Wiesenfarth M, Nöllke P, Fischer A, Brocks D, Gu Z, Park J, Strahm B, Wlodarski M, Yoshimi A, Claus R, Lübbert M, Busch H, Boerries M, Hartmann M, Schönung M, Kilik U, Langstein J, Wierzbinska JA, Pabst C, Garg S, Catalá A, De Moerloose B, Dworzak M, Hasle H, Locatelli F, Masetti R, Schmugge M, Smith O, Stary J, Ussowicz M, van den Heuvel-Eibrink MM, Assenov Y, Schlesner M, Niemeyer C, Flotho C, Plass C. RAS-pathway mutation patterns define epigenetic subclasses in juvenile myelomonocytic leukemia. Nat Commun 2017; 8:2126. [PMID: 29259247 PMCID: PMC5736667 DOI: 10.1038/s41467-017-02177-w] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/13/2017] [Indexed: 01/15/2023] Open
Abstract
Juvenile myelomonocytic leukemia (JMML) is an aggressive myeloproliferative disorder of early childhood characterized by mutations activating RAS signaling. Established clinical and genetic markers fail to fully recapitulate the clinical and biological heterogeneity of this disease. Here we report DNA methylome analysis and mutation profiling of 167 JMML samples. We identify three JMML subgroups with unique molecular and clinical characteristics. The high methylation group (HM) is characterized by somatic PTPN11 mutations and poor clinical outcome. The low methylation group is enriched for somatic NRAS and CBL mutations, as well as for Noonan patients, and has a good prognosis. The intermediate methylation group (IM) shows enrichment for monosomy 7 and somatic KRAS mutations. Hypermethylation is associated with repressed chromatin, genes regulated by RAS signaling, frequent co-occurrence of RAS pathway mutations and upregulation of DNMT1 and DNMT3B, suggesting a link between activation of the DNA methylation machinery and mutational patterns in JMML.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Biopsy
- Child
- Child, Preschool
- Chromatin/genetics
- Chromatin/metabolism
- DNA (Cytosine-5-)-Methyltransferase 1/metabolism
- DNA (Cytosine-5-)-Methyltransferases/metabolism
- DNA Methylation
- DNA Mutational Analysis
- Epigenomics
- Female
- Gene Expression Regulation, Leukemic
- Hematopoietic Stem Cell Transplantation
- Humans
- Infant
- Leukemia, Myelomonocytic, Juvenile/genetics
- Leukemia, Myelomonocytic, Juvenile/mortality
- Leukemia, Myelomonocytic, Juvenile/pathology
- Leukemia, Myelomonocytic, Juvenile/therapy
- Male
- Mutation
- Noonan Syndrome/genetics
- Noonan Syndrome/pathology
- Prognosis
- Prospective Studies
- Protein Tyrosine Phosphatase, Non-Receptor Type 11/genetics
- Protein Tyrosine Phosphatase, Non-Receptor Type 11/metabolism
- Proto-Oncogene Proteins c-cbl
- Proto-Oncogene Proteins p21(ras)/genetics
- Proto-Oncogene Proteins p21(ras)/metabolism
- Signal Transduction/genetics
- Up-Regulation
- DNA Methyltransferase 3B
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Affiliation(s)
- Daniel B Lipka
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke-University, Leipziger Strasse 44, 39120, Magdeburg, Germany.
- Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Tania Witte
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
- Cancer Epigenetics Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Reka Toth
- Computational Epigenomics Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Jing Yang
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Peter Nöllke
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
| | - Alexandra Fischer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
| | - David Brocks
- Cancer Epigenetics Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Zuguang Gu
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Jeongbin Park
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Brigitte Strahm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
| | - Marcin Wlodarski
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), 79106, Freiburg, Germany
| | - Ayami Yoshimi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
| | - Rainer Claus
- Division of Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Michael Lübbert
- Division of Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Hauke Busch
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Stefan-Meier-Strasse 17, 79104, Freiburg, Germany
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Melanie Boerries
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Stefan-Meier-Strasse 17, 79104, Freiburg, Germany
- German Cancer Consortium (DKTK), 79106, Freiburg, Germany
- German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Mark Hartmann
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Maximilian Schönung
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Umut Kilik
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Jens Langstein
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Justyna A Wierzbinska
- Regulation of Cellular Differentiation Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
- Cancer Epigenetics Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Caroline Pabst
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, INF 410, 69120, Heidelberg, Germany
| | - Swati Garg
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, INF 410, 69120, Heidelberg, Germany
| | - Albert Catalá
- Department of Hematology and Oncology, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobrega, Barcelona, Spain
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Zimmermannplatz 10, 1090, Vienna, Austria
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesú Children's Hospital, University of Pavia, Piazza S. Onofrio 4, Rome, 00165, Italy
| | - Riccardo Masetti
- Department of Pediatric Oncology and Hematology, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Owen Smith
- Department of Paediatric Oncology and Haematology, Our Lady's Children's Hospital Crumlin, Dublin, 12, Ireland
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Marek Ussowicz
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | | | - Yassen Assenov
- Computational Epigenomics Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
| | - Matthias Schlesner
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany
- Bioinformatics and Omics Data Analytics (B240), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Charlotte Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), 79106, Freiburg, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine Medical Center, Faculty of Medicine, University of Freiburg, Heiliggeiststrasse 1, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), 79106, Freiburg, Germany
| | - Christoph Plass
- Cancer Epigenetics Group, Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.
- German Cancer Consortium (DKTK), 69120, Heidelberg, Germany.
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35
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Millot F, Guilhot J, Suttorp M, Güneş AM, Sedlacek P, De Bont E, Li CK, Kalwak K, Lausen B, Culic S, Dworzak M, Kaiserova E, De Moerloose B, Roula F, Biondi A, Baruchel A. Prognostic discrimination based on the EUTOS long-term survival score within the International Registry for Chronic Myeloid Leukemia in children and adolescents. Haematologica 2017; 102:1704-1708. [PMID: 28838993 PMCID: PMC5622854 DOI: 10.3324/haematol.2017.170035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023] Open
Abstract
The EUTOS Long-Term Survival score was tested in 350 children with chronic myeloid leukemia in first chronic phase treated with imatinib and registered in the International Registry for Childhood Chronic Myeloid Leukemia. With a median follow up of 3 years (range, 1 month to 6 years) progression and/or death (whichever came first) occurred in 23 patients. For the entire cohort of patients the 5-year progression-free survival rate was 92% (95% CI: 87%-94%) and the 5-year survival accounting for chronic myeloid leukemia deaths was 97% (95% CI: 94%-99%). Of the 309 patients allocated to low (n=199), intermediate (n=68) and high (n=42) risk groups by the EUTOS Long-Term Survival score, events (progression and/or death) occurred in 6.0%, 8.8% and 26.2%, respectively. Estimates of the 5-year progression-free survival rates according to these three risk groups were 96% (95% CI: 92%-98%), 88% (95% CI: 76%-95%) and 67% (95% CI: 48%-81%), respectively. Differences in progression-free survival according to these risk groups were highly significant (P<0.0001, overall). The EUTOS Long-Term Survival score showed better differentiation of progression-free survival than the Sokal (<45 years), Euro and EUTOS scores in children and adolescents with chronic myeloid leukemia and should be considered in therapeutic algorithms. (Trial registered at: www.clinicaltrials.gov NCT01281735).
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Disease Progression
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Infant
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Male
- Prognosis
- Registries
- Treatment Outcome
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Affiliation(s)
| | | | - Meinolf Suttorp
- Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Adalet Meral Güneş
- Department of Pediatric Hematology, Uludağ University Hospital, Görükle Bursa, Turkey
| | - Petr Sedlacek
- Department of Pediatric Hematology-Oncology, University Hospital Motol, Charles University, Prague, Czech Republic
| | - Eveline De Bont
- Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, the Netherlands, and Dutch Childhood Oncology Group, the Hague, the Netherlands
| | - Chi Kong Li
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Krzysztof Kalwak
- Department of Pediatric Hematology Oncology and Transplantation, Wroclaw Medical University, Poland
| | - Birgitte Lausen
- Department of Pediatrics, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Srdjana Culic
- Department of Pediatric Hematology Oncology Immunology and Medical Genetics, Clinical Hospital Split, Croatia
| | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Vienna, Austria
| | - Emilia Kaiserova
- Department of Pediatric Oncology of University Children's Hospital, Bratislava, Slovakia
| | | | - Farah Roula
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Andrea Biondi
- Department of Pediatrics, University of Milano-Bicocca, San Gerardo Hospital, Fondazione MBBM, Monza, Italy
| | - André Baruchel
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
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36
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Meyer C, Burmeister T, Gröger D, Tsaur G, Fechina L, Renneville A, Sutton R, Venn NC, Emerenciano M, Pombo-de-Oliveira MS, Barbieri Blunck C, Almeida Lopes B, Zuna J, Trka J, Ballerini P, Lapillonne H, De Braekeleer M, Cazzaniga G, Corral Abascal L, van der Velden VHJ, Delabesse E, Park TS, Oh SH, Silva MLM, Lund-Aho T, Juvonen V, Moore AS, Heidenreich O, Vormoor J, Zerkalenkova E, Olshanskaya Y, Bueno C, Menendez P, Teigler-Schlegel A, Zur Stadt U, Lentes J, Göhring G, Kustanovich A, Aleinikova O, Schäfer BW, Kubetzko S, Madsen HO, Gruhn B, Duarte X, Gameiro P, Lippert E, Bidet A, Cayuela JM, Clappier E, Alonso CN, Zwaan CM, van den Heuvel-Eibrink MM, Izraeli S, Trakhtenbrot L, Archer P, Hancock J, Möricke A, Alten J, Schrappe M, Stanulla M, Strehl S, Attarbaschi A, Dworzak M, Haas OA, Panzer-Grümayer R, Sedék L, Szczepański T, Caye A, Suarez L, Cavé H, Marschalek R. The MLL recombinome of acute leukemias in 2017. Leukemia 2017; 32:273-284. [PMID: 28701730 PMCID: PMC5808070 DOI: 10.1038/leu.2017.213] [Citation(s) in RCA: 460] [Impact Index Per Article: 65.7] [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: 02/27/2017] [Revised: 04/25/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
Chromosomal rearrangements of the human MLL/KMT2A gene are associated with infant, pediatric, adult and therapy-induced acute leukemias. Here we present the data obtained from 2345 acute leukemia patients. Genomic breakpoints within the MLL gene and the involved translocation partner genes (TPGs) were determined and 11 novel TPGs were identified. Thus, a total of 135 different MLL rearrangements have been identified so far, of which 94 TPGs are now characterized at the molecular level. In all, 35 out of these 94 TPGs occur recurrently, but only 9 specific gene fusions account for more than 90% of all illegitimate recombinations of the MLL gene. We observed an age-dependent breakpoint shift with breakpoints localizing within MLL intron 11 associated with acute lymphoblastic leukemia and younger patients, while breakpoints in MLL intron 9 predominate in AML or older patients. The molecular characterization of MLL breakpoints suggests different etiologies in the different age groups and allows the correlation of functional domains of the MLL gene with clinical outcome. This study provides a comprehensive analysis of the MLL recombinome in acute leukemia and demonstrates that the establishment of patient-specific chromosomal fusion sites allows the design of specific PCR primers for minimal residual disease analyses for all patients.
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Affiliation(s)
- C Meyer
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt/Main, Germany
| | - T Burmeister
- Charité-Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - D Gröger
- Charité-Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - G Tsaur
- Regional Children Hospital 1, Research Institute of Medical Cell Technologies, Pediatric Oncology and Hematology Center, Ural Federal University, Ekaterinburg, Russia
| | - L Fechina
- Regional Children Hospital 1, Research Institute of Medical Cell Technologies, Pediatric Oncology and Hematology Center, Ural Federal University, Ekaterinburg, Russia
| | - A Renneville
- Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille; INSERM, UMR-S 1172, Cancer Research Institute of Lille, Lille, France
| | - R Sutton
- Children's Cancer Institute Australia, Uinversity of NSW Sydney, Sydney, New South Wales, Australia
| | - N C Venn
- Children's Cancer Institute Australia, Uinversity of NSW Sydney, Sydney, New South Wales, Australia
| | - M Emerenciano
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - M S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Barbieri Blunck
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Almeida Lopes
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Zuna
- CLIP, Department of Paediatric Haematology/Oncology, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic
| | - J Trka
- CLIP, Department of Paediatric Haematology/Oncology, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic
| | - P Ballerini
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - H Lapillonne
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - M De Braekeleer
- Université de Bretagne Occidentale, Faculté de Médecine et des Sciences de la Santé, Laboratoire d'Histologie, Embryologie et Cytogénétique & INSERM-U1078, Brest, France
| | - G Cazzaniga
- Centro Ricerca Tettamanti, Clinica Pediatrica Univ. Milano Bicocca, Monza, Italy
| | - L Corral Abascal
- Centro Ricerca Tettamanti, Clinica Pediatrica Univ. Milano Bicocca, Monza, Italy
| | | | - E Delabesse
- CHU Purpan, Laboratoire d'Hématologie, Toulouse, France
| | - T S Park
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - S H Oh
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - M L M Silva
- Cytogenetics Department, Bone Marrow Transplantation Unit, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - T Lund-Aho
- Laboratory of Clinical Genetics, Fimlab Laboratories, Tampere, Finland
| | - V Juvonen
- Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Central Hospital, Turku, Finland
| | - A S Moore
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - O Heidenreich
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J Vormoor
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - E Zerkalenkova
- Dmitry Rogachev National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology, Moscow
| | - Y Olshanskaya
- Dmitry Rogachev National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology, Moscow
| | - C Bueno
- Josep Carreras Leukemia Research Institute, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER de Cancer (CIBERONC), ISCIII, Madrid, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - P Menendez
- Josep Carreras Leukemia Research Institute, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER de Cancer (CIBERONC), ISCIII, Madrid, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - A Teigler-Schlegel
- Department of Experimental Pathology and Cytology, Institute of Pathology, Giessen, Germany
| | - U Zur Stadt
- Center for Diagnostic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - J Lentes
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - G Göhring
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - A Kustanovich
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus
| | - O Aleinikova
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus
| | - B W Schäfer
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - S Kubetzko
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - H O Madsen
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - B Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - X Duarte
- Department of Pediatrics, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - P Gameiro
- Hemato-Oncology Laboratory, UIPM, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - E Lippert
- Hématologie Biologique, CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
| | - A Bidet
- Hématologie Biologique, CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
| | - J M Cayuela
- Laboratoire d'hématologie, AP-HP Saint-Louis, Paris Diderot University, Paris, France
| | - E Clappier
- Laboratoire d'hématologie, AP-HP Saint-Louis, Paris Diderot University, Paris, France
| | - C N Alonso
- Hospital Nacional de Pediatría Prof Dr J. P. Garrahan, Servcio de Hemato-Oncología, Buenos Aires, Argentina
| | - C M Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S Izraeli
- The Chaim Sheba Medical Center, Department of Pediatric Hemato-Oncology and the Cancer Research Center, Tel Aviv, Israel.,Sackler Medical School Tel Aviv University, Tel Aviv, Israel
| | - L Trakhtenbrot
- The Chaim Sheba Medical Center, Department of Pediatric Hemato-Oncology and the Cancer Research Center, Tel Aviv, Israel.,Sackler Medical School Tel Aviv University, Tel Aviv, Israel
| | - P Archer
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - J Hancock
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A Möricke
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - J Alten
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Schrappe
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Stanulla
- Department of Pediatrics, MHH, Hanover, Germany
| | - S Strehl
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - A Attarbaschi
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - M Dworzak
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - O A Haas
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - R Panzer-Grümayer
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - L Sedék
- Department of Microbiology and Immunology, Medical University of Silesia, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - A Caye
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - L Suarez
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - H Cavé
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - R Marschalek
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt/Main, Germany
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Reismüller B, Steiner M, Pichler H, Dworzak M, Urban C, Meister B, Schmitt K, Pötschger U, König M, Mann G, Haas OA, Attarbaschi A. High hyperdiploid acute lymphoblastic leukemia (ALL)-A 25-year population-based survey of the Austrian ALL-BFM (Berlin-Frankfurt-Münster) Study Group. Pediatr Blood Cancer 2017; 64. [PMID: 27804199 DOI: 10.1002/pbc.26327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Approximately 30% of childhood acute lymphoblastic leukemia (ALL) cases are high hyperdiploid (HD). Despite their low relative recurrence risk, this group accounts for the overall largest relapse proportion. PROCEDURE To evaluate potential risk factors in our population-based cohort of patients with HD ALL enrolled in four Austrian ALL-BFM (Berlin-Frankfurt-Münster) studies from 1986 to 2010 (n = 210), we reviewed the clinical, laboratory, and cytogenetic data of the respective cases in relation to their outcome. RESULTS The 5-year event-free (EFS) and overall survival (OS) of the entire group was 83.1 ± 2.7% and 92.0 ± 1.9%, respectively. Univariate analysis revealed that trisomy 17 was significantly associated with a better EFS and OS, whereas trisomy 10 and a modal chromosome number (MCN) > 53 chromosomes were significantly associated with a better OS. Except for the latter, findings remained valid in multivariate analysis. CONCLUSIONS In line with previous studies, our retrospective analysis shows that MCN and specific trisomies are relevant prognostic indicators in an ALL-BFM cohort of patients with HD ALL. However, considering the current dominant role of minimal residual disease monitoring for prognostic stratification in ALL, including this particular subgroup, it is unlikely that this information is compelling enough to be utilized for refined risk classification in future ALL-BFM treatment protocols.
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Affiliation(s)
- Bettina Reismüller
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Manuel Steiner
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Herbert Pichler
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Michael Dworzak
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Christian Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Meister
- Department of Pediatrics, University of Innsbruck, Innsbruck, Austria
| | - Klaus Schmitt
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria
| | - Ulrike Pötschger
- Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Margit König
- Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Georg Mann
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Oskar A Haas
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Andishe Attarbaschi
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
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38
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Millot F, Dupraz C, Guilhot J, Suttorp M, Brizard F, Leblanc T, Güneş AM, Sedlacek P, De Bont E, Li CK, Kalwak K, Lausen B, Culic S, Dworzak M, Kaiserova E, De Moerloose B, Roula F, Biondi A, Baruchel A, Guilhot F. Additional cytogenetic abnormalities and variant t(9;22) at the diagnosis of childhood chronic myeloid leukemia: The experience of the International Registry for Chronic Myeloid Leukemia in Children and Adolescents. Cancer 2017; 123:3609-3616. [PMID: 28497898 DOI: 10.1002/cncr.30767] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 02/06/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the adult population with newly diagnosed chronic myeloid leukemia (CML), variant translocations are usually not considered to be impairing the prognosis, whereas some additional cytogenetic abnormalities (ACAs) are associated with a negative impact on survival. Because of the rarity of CML in the pediatric population, such abnormalities have not been investigated in a large group of children with CML. METHODS The prognostic relevance of variant t(9;22) and ACAs at diagnosis was assessed in 301 children with CML in the chronic phase who were enrolled in the International Registry for Chronic Myeloid Leukemia in Children and Adolescents. RESULTS Overall, 19 children (6.3%) presented with additional cytogenetic findings at diagnosis: 5 children (1.7%) had a variant t(9;22) translocation, 13 children (4.3%) had ACAs, and 1 had both. At 3 years, for children with a classic translocation, children with ACAs, and children with a variant t(9;22) translocation who were treated with imatinib as frontline therapy, the probability of progression-free survival (PFS) was 95% (95% confidence interval [CI], 91%-97%), 100%, and 75% (95% CI, 13%-96%), respectively, and the probability of overall survival (OS) was 98% (95% CI, 95%-100%), 100% (95% CI, 43%-98%), and 75% (95% CI, 13%-96%), respectively. No statistical difference was observed between the patients with classic cytogenetic findings and those with additional chromosomal abnormalities in terms of PFS and OS. CONCLUSIONS In contrast to adults with CML, additional chromosomal abnormalities observed at diagnosis do not seem to have a significant prognostic impact. Cancer 2017;123:3609-16. © 2017 American Cancer Society.
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Affiliation(s)
- Frédéric Millot
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Christelle Dupraz
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Joelle Guilhot
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Meinolf Suttorp
- Department of Pediatrics, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Françoise Brizard
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
| | - Thierry Leblanc
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - Adalet Meral Güneş
- Department of Pediatric Hematology, Uludağ University Hospital, Görükle Bursa, Turkey
| | - Petr Sedlacek
- Department of Pediatric Hematology-Oncology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Evelyne De Bont
- Department of Pediatric Oncology-Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Dutch Childhood Oncology Group, the Hague, the Netherlands
| | - Chi Kong Li
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Krzysztof Kalwak
- Department of Pediatric Hematology-Oncology and Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Birgitte Lausen
- Department of Pediatrics, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Srdjana Culic
- Department of Pediatric Hematology, Oncology, Immunology, and Medical Genetics, Clinical Hospital, Split, Croatia
| | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Vienna, Austria
| | - Emilia Kaiserova
- Department of Pediatric Oncology, University Children's Hospital, Bratislava, Slovakia
| | | | - Farah Roula
- Department of Pediatrics, Saint George Hospital University Medical Centre, Beirut, Lebanon
| | - Andrea Biondi
- Department of Pediatrics, San Gerardo Hospital, University of Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - André Baruchel
- Department of Pediatric Hematology, Robert Debré Hospital, Paris, France
| | - François Guilhot
- INSERM Clinical Investigation Center 1402, Poitiers University, Poitiers, France
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39
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Obenauer JC, Kavelaars FG, Sanders MA, de Vries ACH, de Haas V, Beverloo HB, De Moerloose B, Lammens T, Dworzak M, Hoogenboezem RM, Valk PJM, Touw IP, van den Heuvel-Eibrink MM. Recurrently affected genes in juvenile myelomonocytic leukaemia. Br J Haematol 2017; 182:135-138. [DOI: 10.1111/bjh.14737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Julia C. Obenauer
- Department of Haematology; Erasmus University Medical Centre; Rotterdam the Netherlands
- Department of Paediatric Oncology-Haematology; Erasmus University Medical Centre/Sophia Children's Hospital; Rotterdam the Netherlands
| | - François G. Kavelaars
- Department of Haematology; Erasmus University Medical Centre; Rotterdam the Netherlands
| | - Mathijs A. Sanders
- Department of Haematology; Erasmus University Medical Centre; Rotterdam the Netherlands
| | - Andrica C. H. de Vries
- Department of Paediatric Oncology-Haematology; Erasmus University Medical Centre/Sophia Children's Hospital; Rotterdam the Netherlands
| | - Valerie de Haas
- Dutch Childhood Oncology Group (DCOG/SKION); The Hague the Netherlands
| | - H. Berna Beverloo
- Department of Clinical Genetics; Erasmus University Medical Centre; Rotterdam the Netherlands
- Dutch Working Group on Haemato-Oncologic Genome Diagnostics; Rotterdam the Netherlands
| | - Barbara De Moerloose
- Department of Paediatric Haematology-Oncology and Stem Cell Transplantation; Ghent University Hospital; Ghent Belgium
| | - Tim Lammens
- Department of Paediatric Haematology-Oncology and Stem Cell Transplantation; Ghent University Hospital; Ghent Belgium
| | - Michael Dworzak
- St Anna Children's Hospital and Children's Cancer Research Institute; Department of Paediatrics; Medical University of Vienna; Vienna Austria
| | - Remco M. Hoogenboezem
- Department of Haematology; Erasmus University Medical Centre; Rotterdam the Netherlands
| | - Peter J. M. Valk
- Department of Haematology; Erasmus University Medical Centre; Rotterdam the Netherlands
| | - Ivo P. Touw
- Department of Haematology; Erasmus University Medical Centre; Rotterdam the Netherlands
| | - Marry M. van den Heuvel-Eibrink
- Department of Paediatric Oncology-Haematology; Erasmus University Medical Centre/Sophia Children's Hospital; Rotterdam the Netherlands
- Princess Màxima Centre for Paediatric Oncology (PMC); Utrecht the Netherlands
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40
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Ebinger S, Özdemir EZ, Ziegenhain C, Tiedt S, Castro Alves C, Grunert M, Dworzak M, Lutz C, Turati VA, Enver T, Horny HP, Sotlar K, Parekh S, Spiekermann K, Hiddemann W, Schepers A, Polzer B, Kirsch S, Hoffmann M, Knapp B, Hasenauer J, Pfeifer H, Panzer-Grümayer R, Enard W, Gires O, Jeremias I. Characterization of Rare, Dormant, and Therapy-Resistant Cells in Acute Lymphoblastic Leukemia. Cancer Cell 2016; 30:849-862. [PMID: 27916615 PMCID: PMC5156313 DOI: 10.1016/j.ccell.2016.11.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 06/11/2016] [Accepted: 10/31/2016] [Indexed: 01/06/2023]
Abstract
Tumor relapse is associated with dismal prognosis, but responsible biological principles remain incompletely understood. To isolate and characterize relapse-inducing cells, we used genetic engineering and proliferation-sensitive dyes in patient-derived xenografts of acute lymphoblastic leukemia (ALL). We identified a rare subpopulation that resembled relapse-inducing cells with combined properties of long-term dormancy, treatment resistance, and stemness. Single-cell and bulk expression profiling revealed their similarity to primary ALL cells isolated from pediatric and adult patients at minimal residual disease (MRD). Therapeutically adverse characteristics were reversible, as resistant, dormant cells became sensitive to treatment and started proliferating when dissociated from the in vivo environment. Our data suggest that ALL patients might profit from therapeutic strategies that release MRD cells from the niche.
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Affiliation(s)
- Sarah Ebinger
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany
| | - Erbey Ziya Özdemir
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany
| | - Christoph Ziegenhain
- Anthropology and Human Genomics, Department Biology II, Faculty of Biology, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | - Sebastian Tiedt
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany
| | - Catarina Castro Alves
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany
| | - Michaela Grunert
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany
| | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Kinderspital, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Lutz
- Department of Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | | | - Tariq Enver
- University College London Cancer Institute, London WC1E, UK
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Karl Sotlar
- Institute of Pathology, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Swati Parekh
- Anthropology and Human Genomics, Department Biology II, Faculty of Biology, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | - Karsten Spiekermann
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, 81377 Munich, Germany; German Consortium for Translational Cancer Research (DKTK), Partnering Site, Munich, 81377 Munich, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, 81377 Munich, Germany; German Consortium for Translational Cancer Research (DKTK), Partnering Site, Munich, 81377 Munich, Germany
| | - Aloys Schepers
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany
| | - Bernhard Polzer
- Project Group Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 93053 Regensburg, Germany
| | - Stefan Kirsch
- Project Group Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 93053 Regensburg, Germany
| | - Martin Hoffmann
- Project Group Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 93053 Regensburg, Germany
| | - Bettina Knapp
- Institute of Computational Biology, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 85764 Neuherberg, Germany
| | - Jan Hasenauer
- Institute of Computational Biology, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 85764 Neuherberg, Germany; Department of Mathematics, Technische Universität München (TUM), 85748 Munich, Germany
| | - Heike Pfeifer
- Department of Medicine, Hematology and Oncology, Goethe University, 60590 Frankfurt, Germany
| | - Renate Panzer-Grümayer
- Children's Cancer Research Institute and St. Anna Kinderspital, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang Enard
- Anthropology and Human Genomics, Department Biology II, Faculty of Biology, Ludwig-Maximilians-Universität München, 82152 Martinsried, Germany
| | - Olivier Gires
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Irmela Jeremias
- Department of Gene Vectors, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), 81377 Munich, Germany; German Consortium for Translational Cancer Research (DKTK), Partnering Site, Munich, 81377 Munich, Germany; Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University München, 80337 Munich, Germany.
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Creutzig U, Zimmermann M, Reinhardt D, Rasche M, von Neuhoff C, Alpermann T, Dworzak M, Perglerová K, Zemanova Z, Tchinda J, Bradtke J, Thiede C, Haferlach C. Changes in cytogenetics and molecular genetics in acute myeloid leukemia from childhood to adult age groups. Cancer 2016; 122:3821-3830. [DOI: 10.1002/cncr.30220] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/09/2016] [Accepted: 06/30/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Ursula Creutzig
- Pediatric Hematology and Oncology, Hannover Medical School; Hannover Germany
| | - Martin Zimmermann
- Pediatric Hematology and Oncology, Hannover Medical School; Hannover Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology; University of Duisburg-Essen; Essen Germany
| | - Mareike Rasche
- Department of Pediatric Hematology-Oncology; University of Duisburg-Essen; Essen Germany
| | - Christine von Neuhoff
- Department of Pediatric Hematology-Oncology; University of Duisburg-Essen; Essen Germany
| | | | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute; Medical University of Vienna; Vienna Austria
| | | | - Zuzana Zemanova
- Center of Oncocytogenetics, Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine; Charles University; Prague Czech Republic
| | - Joelle Tchinda
- Pediatric Hematology/Oncology; University of Zurich; Zurich Switzerland
| | - Jutta Bradtke
- Institute for Pathology; University Hospital of Giessen and Marburg; Giessen Germany
| | - Christian Thiede
- Medical Clinic and Policlinic I, Carl Gustav Carus University Hospital; Technical University; Dresden Germany
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Creutzig U, Rössig C, Dworzak M, Stary J, von Stackelberg A, Wössmann W, Zimmermann M, Reinhardt D. Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis. Pediatr Blood Cancer 2016; 63:640-5. [PMID: 26670831 DOI: 10.1002/pbc.25855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/21/2015] [Accepted: 11/04/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML-BFM (Berlin-Frankfurt-Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed. PATIENTS Two hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis. RESULTS ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (P(χ(2) ) <0.0001). CONCLUSION Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. ET/LPh shows a trend toward reduced ED rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC.
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Affiliation(s)
- Ursula Creutzig
- Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Claudia Rössig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany
| | - Wilhelm Wössmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
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43
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Klein K, Kaspers G, Harrison CJ, Beverloo HB, Reedijk A, Bongers M, Cloos J, Pession A, Reinhardt D, Zimmerman M, Creutzig U, Dworzak M, Alonzo T, Johnston D, Hirsch B, Zapotocky M, De Moerloose B, Fynn A, Lee V, Taga T, Tawa A, Auvrignon A, Zeller B, Forestier E, Salgado C, Balwierz W, Popa A, Rubnitz J, Raimondi S, Gibson B. Clinical Impact of Additional Cytogenetic Aberrations, cKIT and RAS Mutations, and Treatment Elements in Pediatric t(8;21)-AML: Results From an International Retrospective Study by the International Berlin-Frankfurt-Münster Study Group. J Clin Oncol 2015; 33:4247-58. [PMID: 26573082 DOI: 10.1200/jco.2015.61.1947] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This retrospective cohort study aimed to determine the predictive relevance of clinical characteristics, additional cytogenetic aberrations, and cKIT and RAS mutations, as well as to evaluate whether specific treatment elements were associated with outcomes in pediatric t(8;21)-positive patients with acute myeloid leukemia (AML). PATIENTS AND METHODS Karyotypes of 916 pediatric patients with t(8;21)-AML were reviewed for the presence of additional cytogenetic aberrations, and 228 samples were screened for presence of cKIT and RAS mutations. Multivariable regression models were used to assess the relevance of anthracyclines, cytarabine, and etoposide during induction and overall treatment. End points were the probability of achieving complete remission, cumulative incidence of relapse (CIR), probability of event-free survival, and probability of overall survival. RESULTS Of 838 patients included in final analyses, 92% achieved complete remission. The 5-year overall survival, event-free survival, and CIR were 74%, 58%, and 26%, respectively. cKIT mutations and RAS mutations were not significantly associated with outcome. Patients with deletions of chromosome arm 9q [del(9q); n = 104] had a lower probability of complete remission (P = .01). Gain of chromosome 4 (+4; n = 21) was associated with inferior CIR and survival (P < .01). Anthracycline doses greater than 150 mg/m(2) and etoposide doses greater than 500 mg/m(2) in the first induction course and high-dose cytarabine 3 g/m(2) during induction were associated with better outcomes on various end points. Cumulative doses of cytarabine greater than 30 g/m(2) and etoposide greater than 1,500 mg/m(2) were associated with lower CIR rates and better probability of event-free survival. CONCLUSION Pediatric patients with t(8;21)-AML and additional del(9q) or additional +4 might not be considered at good risk. Patients with t(8;21)-AML likely benefit from protocols that have high doses of anthracyclines, etoposide, and cytarabine during induction, as well as from protocols comprising cumulative high doses of cytarabine and etoposide.
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Affiliation(s)
- Kim Klein
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Gertjan Kaspers
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Christine J Harrison
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - H Berna Beverloo
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Ardine Reedijk
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Mathilda Bongers
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Jacqueline Cloos
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Andrea Pession
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Dirk Reinhardt
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Martin Zimmerman
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Ursula Creutzig
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Michael Dworzak
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Todd Alonzo
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Donna Johnston
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Betsy Hirsch
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Michal Zapotocky
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Barbara De Moerloose
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Alcira Fynn
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Vincent Lee
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Takashi Taga
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Akio Tawa
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Anne Auvrignon
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Bernward Zeller
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Erik Forestier
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Carmen Salgado
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Walentyna Balwierz
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Alexander Popa
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Jeffrey Rubnitz
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Susana Raimondi
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
| | - Brenda Gibson
- Kim Klein, Gertjan Kaspers, Jacqueline Cloos, and Mathilda Bongers, Vrije Universiteit University Medical Center Amsterdam; Gertjan Kaspers and Ardine Reedijk, Dutch Childhood Oncology Group, The Hague; H. Berna Beverloo, Erasmus Medical Center, Rotterdam, the Netherlands; Christine J. Harrison, Newcastle University, Newcastle upon Tyne; Brenda Gibson, Royal Hospital for Sick Children, Glasgow, United Kingdom; Andrea Pession, Italian Association of Pediatric Hematology Oncology, Bologna, Italy; Dirk Reinhardt, Berlin-Frankfurt-Münster (BFM) -Germany, Essen; Martin Zimmerman and Ursula Creutzig, BFM-Germany, Hannover, Germany; Michael Dworzak, BFM-Austria, Vienna, Austria; Todd Alonzo, Donna Johnston, and Betsy Hirsch, Children's Oncology Group (COG) including Children's Cancer Group and Pediatric Oncology Group, Philadelphia (COG chair's office), PA; Michal Zapotocky, Czech Paediatric Hematology Working Group, Prague, Czech Republic; Barbara De Moerloose, European Organisation for Research and Treatment of Cancer-Children's Leukemia Group, Brussels, Belgium; Alcira Flynn, Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina; Vincent Lee, Hong Kong Paediatric Haematology and Oncology Study Group, Hong Kong, Special Administrative Region, People's Republic of China; Takashi Taga, Japanese Pediatric Leukemia/Lymphoma Study Group, Otsu; Akio Tawa, Japanese Pediatric Leukemia/Lymphoma Study Group, Osaka, Japan; Anne Auvrignon, French Leucémie Aiguë Myéloblastique Enfant Cooperative Group, Paris, France; Bernward Zeller, Nordic Society of Paediatric Haematology and Oncology, Oslo, Norway; Erik Forestier, Nordic Society of Paediatric Haematology and Oncology, Umeå, Sweden; Carmen Salgado, The National Program for Antineoplastic Drugs for Children, Santiago, Chile; Walentyna Balwierz, Polish Pediatric Leukemia Lymphoma Study Group, Krakow, Poland; Alexander Popa, Russian Acute Myeloid Leukemia Study Group, Moscow, Russia; and Jeffrey Rubnitz and
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44
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Niemeyer CM, Loh ML, Cseh A, Cooper T, Dvorak CC, Chan R, Xicoy B, Germing U, Kojima S, Manabe A, Dworzak M, De Moerloose B, Starý J, Smith OP, Masetti R, Catala A, Bergstraesser E, Ussowicz M, Fabri O, Baruchel A, Cavé H, Zwaan M, Locatelli F, Hasle H, van den Heuvel-Eibrink MM, Flotho C, Yoshimi A. Criteria for evaluating response and outcome in clinical trials for children with juvenile myelomonocytic leukemia. Haematologica 2015; 100:17-22. [PMID: 25552679 DOI: 10.3324/haematol.2014.109892] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Juvenile myelomonocytic leukemia is a rare myeloproliferative disease in young children. While hematopoietic stem cell transplantation remains the only curative therapeutic option for most patients, children with juvenile myelomonocytic leukemia increasingly receive novel agents in phase I-II clinical trials as pre-transplant therapy or therapy for relapse after transplantation. However, response criteria or definitions of outcome for standardized evaluation of treatment effect in patients with juvenile myelomonocytic leukemia are currently lacking. Here we propose criteria to evaluate the response to the non-transplant therapy and definitions of remission status after hematopoietic stem cell transplantation. For the evaluation of non-transplant therapy, we defined 6 clinical variables (white blood cell count, platelet count, hematopoietic precursors and blasts in peripheral blood, bone marrow blast percentage, spleen size and extramedullary disease) and 3 genetic variables (cytogenetic, molecular and chimerism response) which serve to describe the heterogeneous picture of response to therapy in each individual case. It is hoped that these criteria will facilitate the comparison of results between clinical trials in juvenile myelomonocytic leukemia.
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Affiliation(s)
- Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology University of Freiburg, Germany
| | - Mignon L Loh
- Department of Pediatrics and the Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Annamaria Cseh
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology University of Freiburg, Germany
| | - Todd Cooper
- Aflac Cancer and Blood Disorders Center/Children's Healthcare of Atlanta/Emory University, Atlanta, GA, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplant, Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Rebecca Chan
- Department of Pediatrics, The Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Blanca Xicoy
- Department of Hematology, Hospital Germans Trias i Pujol and Institut Català d'Oncologia-José Carreras Leukemia Research Institute, Badalona, Spain
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Manabe
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Austria
| | | | - Jan Starý
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Czech Pediatric Hematology Working Group, Prague, Czech Republic
| | - Owen P Smith
- Pediatric Oncology and Hematology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Riccardo Masetti
- Department of Pediatric Oncology and Hematology, University of Bologna, Italy
| | - Albert Catala
- Department of Hematology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Eva Bergstraesser
- Department of Hematology and Oncology, University Children's Hospital, Zurich, Switzerland
| | - Marek Ussowicz
- Department of Pediatric Oncology, Hematology and BMT, Wroclaw Medical University, Poland
| | - Oskana Fabri
- Department of Hematology and Transfusiology, Comenius University, Bratislava, Slovakia
| | - André Baruchel
- Department of Pediatric Hematology of Robert Debré Hospital and Paris Diderot University, Paris, France
| | - Hélène Cavé
- Department of Genetics, Hôpital Robert Debré, and Paris Diderot University, Paris, France
| | - Michel Zwaan
- ErasmusMC-Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, and the Netherlands and ITCC
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, University of Pavia, Italy
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Marry M van den Heuvel-Eibrink
- ErasmusMC-Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, and Dutch Childhood Oncology Group, The Hague, The Netherlands
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology University of Freiburg, Germany
| | - Ayami Yoshimi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology University of Freiburg, Germany
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45
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Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, De Bont ESJM, De Moerloose B, Dworzak M, Gibson BES, Hasle H, Leverger G, Locatelli F, Ragu C, Ribeiro RC, Rizzari C, Rubnitz JE, Smith OP, Sung L, Tomizawa D, van den Heuvel-Eibrink MM, Creutzig U, Kaspers GJL. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia. J Clin Oncol 2015; 33:2949-62. [PMID: 26304895 DOI: 10.1200/jco.2015.62.8289] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diagnosis, treatment, response monitoring, and outcome of pediatric acute myeloid leukemia (AML) have made enormous progress during the past decades. Because AML is a rare type of childhood cancer, with an incidence of approximately seven occurrences per 1 million children annually, national and international collaborative efforts have evolved. This overview describes these efforts and includes a summary of the history and contributions of each of the main collaborative pediatric AML groups worldwide. The focus is on translational and clinical research, which includes past, current, and future clinical trials. Separate sections concern acute promyelocytic leukemia, myeloid leukemia of Down syndrome, and relapsed AML. A plethora of novel antileukemic agents that have emerged, including new classes of drugs, are summarized as well. Finally, an important aspect of the treatment of pediatric AML--supportive care--and late effects are discussed. The future is bright, with a wide range of emerging innovative therapies and with more and more international collaboration that ultimately aim to cure all children with AML, with fewer adverse effects and without late effects.
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Affiliation(s)
- C Michel Zwaan
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Edward A Kolb
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Dirk Reinhardt
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jonas Abrahamsson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Souichi Adachi
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Richard Aplenc
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Eveline S J M De Bont
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Barbara De Moerloose
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Michael Dworzak
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Brenda E S Gibson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Henrik Hasle
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Guy Leverger
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Franco Locatelli
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Christine Ragu
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Raul C Ribeiro
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Carmelo Rizzari
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jeffrey E Rubnitz
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Owen P Smith
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Lillian Sung
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Daisuke Tomizawa
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Marry M van den Heuvel-Eibrink
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Ursula Creutzig
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Gertjan J L Kaspers
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
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Karawajew L, Dworzak M, Ratei R, Rhein P, Gaipa G, Buldini B, Basso G, Hrusak O, Ludwig WD, Henze G, Seeger K, von Stackelberg A, Mejstrikova E, Eckert C. Minimal residual disease analysis by eight-color flow cytometry in relapsed childhood acute lymphoblastic leukemia. Haematologica 2015; 100:935-44. [PMID: 26001791 DOI: 10.3324/haematol.2014.116707] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/30/2015] [Indexed: 01/17/2023] Open
Abstract
Multiparametric flow cytometry is an alternative approach to the polymerase chain reaction method for evaluating minimal residual disease in treatment protocols for primary acute lymphoblastic leukemia. Given considerable differences between primary and relapsed acute lymphoblastic leukemia treatment regimens, flow cytometric assessment of minimal residual disease in relapsed leukemia requires an independent comprehensive investigation. In the present study we addressed evaluation of minimal residual disease by flow cytometry in the clinical trial for childhood relapsed acute lymphoblastic leukemia using eight-color flow cytometry. The major challenge of the study was to reliably identify low amounts of residual leukemic cells against the complex background of regeneration, characteristic of follow-up samples during relapse treatment. In a prospective study of 263 follow-up bone marrow samples from 122 patients with B-cell precursor acute lymphoblastic leukemia, we tested various B-cell markers, adapted the antibody panel to the treatment protocol, and evaluated its performance by a blinded parallel comparison with the polymerase chain reaction data. The resulting eight-color single-tube panel showed a consistently high overall concordance (P<0.001) and, under optimal conditions, sensitivity similar to that of the reference polymerase chain reaction method. Overall, evaluation of minimal residual disease by flow cytometry can be successfully integrated into the clinical management of relapsed childhood acute lymphoblastic leukemia either as complementary to the polymerase chain reaction or as an independent risk stratification tool. ALL-REZ BFM 2002 clinical trial information: NCT00114348.
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Affiliation(s)
- Leonid Karawajew
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Berlin, Germany
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Austria
| | - Richard Ratei
- Robert-Roessle-Clinic in the HELIOS Klinikum Berlin, Germany
| | - Peter Rhein
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Berlin, Germany
| | - Giuseppe Gaipa
- Tettamanti Research Center, Department of Pediatrics, University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Barbara Buldini
- Laboratory of Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Padova, Italy
| | - Giuseppe Basso
- Laboratory of Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Padova, Italy
| | - Ondrej Hrusak
- Department of Pediatric Hematology and Oncology, Charles University 2 Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | | | - Günter Henze
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Berlin, Germany
| | - Karl Seeger
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Berlin, Germany
| | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Berlin, Germany
| | - Ester Mejstrikova
- Department of Pediatric Hematology and Oncology, Charles University 2 Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Cornelia Eckert
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Berlin, Germany
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47
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Creutzig U, Dworzak M, Zimmermann M, Bourquin JP, Gruhn B, Fleischhack G, Graf N, Klingebiel T, Kremens B, Lehrnbecher T, von Neuhoff C, von Stackelberg A, Stray J, Reinhardt D. Randomised Introduction of 2-CDA as Intensification during Consolidation for Children with High-risk AML--results from Study AML-BFM 2004. Klin Padiatr 2015; 227:116-22. [PMID: 25985446 DOI: 10.1055/s-0035-1548816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The outcome in children and adolescents with high-risk (HR) acute myeloid leukemia (AML) is still unsatisfactory. Therefore, in study AML-BFM 2004 we aimed to improve outcome of HR-patients by adding moderately dosed 2-Chloro-2-Deoxyadenosine (2-CDA) to the respective consolidation treatment backbone without increasing toxicity. The aim was to improve prognosis especially in FAB M4/M5/MLL patients, who represent the largest subgroup of HR patients. PATIENTS AND METHODS In total, 343 children and adolescents with HR-AML were randomized to receive or not 2-CDA (6 mg/m²/d, days 1, 3) in combination with cytarabine/idarubicine (AI=500 mg/m² cytarabine 5 days continuous infusion plus 7 mg/m²/d idarubicin, days 3 and 5). RESULTS RESULTS for patients of the AI/2-CDA arm (n=168) vs. the AI-arm (n=175) were similar: 5-year overall survival 68±4 vs. 72±4%, plogrank=0.38, event-free survival 53±4 vs. 49±4%, plogrank=0.77; cumulative incidence of relapse at 5 years: 35±4 vs. 37±4%, p(Gray)=0.89. RESULTS in patients with MLL rearrangement or FAB M4/M5 were also similar in the treatment groups. In addition, toxicities did not differ between the two arms. CONCLUSION We conclude that additional, moderate dose 2-CDA does not improve prognosis in HR-patients when given during consolidation treatment. Its effect might be too low in this multidrug regimen, where the strongest effects are achieved during induction, or the chosen dose of 2-CDA might have been too low.
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Affiliation(s)
- U Creutzig
- Department of Pediatric Hematology and Oncology, Children's Hospital, Hannover Medical School, Hannover, Germany
| | - M Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - M Zimmermann
- Department of Pediatric Hematology and Oncology, Children's Hospital, Hannover Medical School, Hannover, Germany
| | - J-P Bourquin
- Pediatric Hematology/Oncology, Zürich, University of Zurich, Switzerland
| | - B Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - G Fleischhack
- Paediatric Hematology and Oncology, Medical Center, University of Essen, Essen, Germany
| | - N Graf
- Paediatric Haematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
| | - T Klingebiel
- Pediatric Hematology, Oncology and Hemostaseology, University Children's Hospital of Frankfurt/Main, Goethe-University Frankfurt/Main, Frankfurt, Germany
| | - B Kremens
- Paediatric Hematology and Oncology, Medical Center, University of Essen, Essen, Germany
| | - T Lehrnbecher
- Pediatric Hematology, Oncology and Hemostaseology, University Children's Hospital of Frankfurt/Main, Goethe-University Frankfurt/Main, Frankfurt, Germany
| | - C von Neuhoff
- Paediatric Hematology and Oncology, Medical Center, University of Essen, Essen, Germany
| | - A von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J Stray
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - D Reinhardt
- Paediatric Hematology and Oncology, Medical Center, University of Essen, Essen, Germany
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48
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Schweitzer J, Zimmermann M, Rasche M, von Neuhoff C, Creutzig U, Dworzak M, Reinhardt D, Klusmann JH. Improved outcome of pediatric patients with acute megakaryoblastic leukemia in the AML-BFM 04 trial. Ann Hematol 2015; 94:1327-36. [PMID: 25913479 PMCID: PMC4488462 DOI: 10.1007/s00277-015-2383-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 03/24/2015] [Accepted: 04/14/2015] [Indexed: 01/11/2023]
Abstract
Despite recent advances in the treatment of children with acute megakaryoblastic leukemia (AMKL) using intensified treatment protocols, clear prognostic indicators, and treatment recommendations for this acute myeloid leukemia (AML) subgroup are yet to be defined. Here, we report the outcome of 97 pediatric patients with de novo AMKL (excluding Down syndrome [DS]) enrolled in the prospective multicenter studies AML-BFM 98 and AML-BFM 04 (1998-2014). AMKL occurred in 7.4 % of pediatric AML cases, at younger age (median 1.44 years) and with lower white blood cell count (mean 16.5 × 109/L) as compared to other AML subgroups. With 60 ± 5 %, children with AMKL had a lower 5-year overall survival (5-year OS; vs. 68 ± 1 %, Plog rank = 0.038). Yet, we achieved an improved 5-year OS in AML-BFM 04 compared to AML-BFM 98 (70 ± 6 % vs. 45 ± 8 %, Plog rank = 0.041). Allogeneic hematopoietic stem cell transplantation in first remission did not provide a significant survival benefit (5-year OS 70 ± 11 % vs. 63 ± 6 %; PMantel-Byar = 0.85). Cytogenetic data were available for n = 78 patients. AMKL patients with gain of chromosome 21 had a superior 5-year OS (80 ± 9 %, Plog rank = 0.034), whereas translocation t(1;22)(p13;q13) was associated with an inferior 5-year event-free survival (38 ± 17 %, Plog rank = 0.04). However, multivariate analysis showed that treatment response (bone marrow morphology on day 15 and 28) was the only independent prognostic marker (RR = 4.39; 95 % CI, 1.97–9.78). Interestingly, GATA1-mutations were detected in six patients (11 %) without previously known trisomy 21. Thus, AMKL (excluding DS) remains an AML subgroup with inferior outcome. Nevertheless, with intensive therapy regimens, a steep increase in the survival rates was achieved.
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Affiliation(s)
- Jana Schweitzer
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
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49
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Bugarin C, Sarno J, Palmi C, Savino AM, te Kronnie G, Dworzak M, Shumich A, Buldini B, Maglia O, Sala S, Bronzini I, Bourquin JP, Mejstrikova E, Hrusak O, Luria D, Basso G, Izraeli S, Biondi A, Cazzaniga G, Gaipa G. Fine tuning of surface CRLF2 expression and its associated signaling profile in childhood B-cell precursor acute lymphoblastic leukemia. Haematologica 2015; 100:e229-32. [PMID: 25862705 DOI: 10.3324/haematol.2014.114447] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Cristina Bugarin
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | - Jolanda Sarno
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | - Chiara Palmi
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | - Angela Maria Savino
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | | | - Michael Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Dept. of Pediatrics, Medical University of Vienna, Austria
| | - Angela Shumich
- Children's Cancer Research Institute and St. Anna Children's Hospital, Dept. of Pediatrics, Medical University of Vienna, Austria
| | | | - Oscar Maglia
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | - Simona Sala
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | | | | | - Ester Mejstrikova
- Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Charles University Prague, 2 Medical School, Czech Republic
| | - Ondrej Hrusak
- Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Charles University Prague, 2 Medical School, Czech Republic
| | - Drorit Luria
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel
| | | | - Shai Izraeli
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel
| | - Andrea Biondi
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy Department of Pediatrics, Hospital San Gerardo/Fondazione MBBM, Monza, Italy
| | - Giovanni Cazzaniga
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
| | - Giuseppe Gaipa
- Pediatric Clinic, University of Milano Bicocca, M. Tettamanti Research Center, Monza, Italy
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50
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Aalbers AM, van den Heuvel-Eibrink MM, Baumann I, Dworzak M, Hasle H, Locatelli F, De Moerloose B, Schmugge M, Mejstrikova E, Nováková M, Zecca M, Zwaan CM, Te Marvelde JG, Langerak AW, van Dongen JJM, Pieters R, Niemeyer CM, van der Velden VHJ. Bone marrow immunophenotyping by flow cytometry in refractory cytopenia of childhood. Haematologica 2014; 100:315-23. [PMID: 25425683 DOI: 10.3324/haematol.2014.107706] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Refractory cytopenia of childhood is the most common type of childhood myelodysplastic syndrome. Because the majority of children with refractory cytopenia have a normal karyotype and a hypocellular bone marrow, differentiating refractory cytopenia from the immune-mediated bone marrow failure syndrome (very) severe aplastic anemia can be challenging. Flow cytometric immunophenotyping of bone marrow has been shown to be a valuable diagnostic tool in differentiating myelodysplastic syndrome from non-clonal cytopenias in adults. Here, we performed the first comprehensive flow cytometric analysis of immature myeloid, lymphoid cells and erythroid cells, and granulocytes, monocytes, and lymphoid cells in bone marrow obtained from a large prospective cohort of 81 children with refractory cytopenia. Children with refractory cyotopenia had a strongly reduced myeloid compartment, but not as severe as children with aplastic anemia. Furthermore, the number of flow cytometric abnormalities was significantly higher in children with refractory cytopenia than in healthy controls and in children with aplastic anemia, but lower than in advanced myelodysplastic syndrome. We conclude that flow cytometric immunophenotyping could be a relevant addition to histopathology in the diagnosis of refractory cytopenia of childhood. (The multi-center studies EWOG-MDS RC06 and EWOG-MDS 2006 are registered at clinicaltrials.gov identifiers 00499070 and 00662090, respectively).
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Affiliation(s)
- Anna M Aalbers
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Irith Baumann
- Department of Pathology, Clinical Centre South West, Böblingen Clinics, Germany
| | - Michael Dworzak
- St. Anna Children's Hospital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Austria
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Franco Locatelli
- Department of Pediatric Hematology-Oncology, IRCCS Ospedale Bambino Gesù, Rome, University of Pavia, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology/Oncology, Ghent University Hospital, Ghent, Belgium
| | - Markus Schmugge
- Department of Hematology, University Children's Hospital, Zurich, Switzerland
| | - Ester Mejstrikova
- Department of Pediatric Hematology/Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michaela Nováková
- Department of Pediatric Hematology/Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marco Zecca
- Pediatric Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen G Te Marvelde
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jacques J M van Dongen
- Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rob Pieters
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Germany
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