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Mason G, Aghajani R, Dance B, Othman J, Goodwin L, Stevenson W, Mackinlay N. Chronic myeloproliferative neoplasm in adulthood in CBL syndrome harboring a splice-site CBL variant alongside a novel constitutional CSF3R variant. EJHaem 2024; 5:397-402. [PMID: 38633130 PMCID: PMC11020124 DOI: 10.1002/jha2.864] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 04/19/2024]
Abstract
Casitas B-cell lineage (CBL) syndrome is a rare RASopathy known to predispose to CBL-mutated juvenile myelomonocytic leukemia (JMML) in childhood. Adulthood acute myeloid leukemia arising out of a genetic aberrancies consistent with prior CBL-mutated JMML has been twice previously described, but chronic myeloproliferative neoplasia has not. We present a case of progressive myeloproliferative neoplasm in adulthood in the context of CBL syndrome alongside a novel CSF3R variant. We also review pathogenic splice-site mutations in CBL-mutated JMML.
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Affiliation(s)
- George Mason
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Rhian Aghajani
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Brieanna Dance
- Department of Clinical GeneticsChildren's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Jad Othman
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Linda Goodwin
- Department of Clinical GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - William Stevenson
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
- Northern Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Naomi Mackinlay
- Department of Transfusion and HaematologyRoyal North Shore HospitalSydneyNew South WalesAustralia
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Hu GH, Zhang XH, Wang Y, Xu LP, Hou XL, Cheng YF, Huang XJ. The prognosis of haploidentical hematopoietic stem cell transplantation in infants and patients under 3 years old with acute leukemia. Clin Transplant 2024; 38:e15247. [PMID: 38375911 DOI: 10.1111/ctr.15247] [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: 08/16/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients <3 years of age remains controversial. Data on haploidentical donor (HID) transplants in this age group is limited. PATIENTS AND METHODS We retrospectively analyzed the prognosis of 97 patients with acute leukemia aged <3 years who underwent HID transplantation at our institute. RESULTS With a median follow-up of 45 months, the 3-year disease-free survival (DFS), overall survival (OS), and 3-year cumulative incidence rate of treatment-related mortality were 69.3% (95% confidence interval (CI): 59.9%-78.7%), 74.2% (95% CI: 65.2%-83.2%), and 3.6% (95% CI: 0.9%-9.7%) in all 97 patients, respectively. The 3-year DFS and OS rate in patients diagnosed <1 year and patients diagnosed ≥1 year were comparable: 77.8% (95% CI: 62.2%-93.4%) versus 66.3% (95% CI: 55.0%-77.6%, p = .253) and 82.5% (95% CI: 66.3-98.7%) versus 72.8% (95% CI: 61.9%-83.7%, p = .153), respectively. At the last follow-up, 23 patients had died, and 20 had died of relapse. Multivariate analysis revealed that positive pre-HSCT flow cytometric minimal residual disease (hazard ratio 5.605, p = .000) and AML-M7 expression (hazard ratio 2.906, p = .014) were independent adverse prognostic variables for relapse. CONCLUSIONS HID transplantation is potent and safe for infants and young patients with acute leukemia. Relapse is the primary cause of treatment failure.
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Affiliation(s)
- Guan-Hua Hu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Xin-Lin Hou
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yi-Fei Cheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
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Pérez-Saldivar ML, Flores-García MK, Núñez-Villegas N, Fajardo-Gutiérrez A, Medina-Sanson A, Jiménez-Hernández E, Martín-Trejo JA, López-Santiago N, Peñaloza-González JG, Cortés-Herrera B, Merino-Pasaye LE, Amador-Sánchez R, García-López LR, Pérez-Lorenzana H, Román-Zepeda PF, Castañeda-Echevarría A, López-Caballero MG, Martínez-Silva SI, Rivera-González J, Granados-Kraulles J, Flores-Botello J, Medrano-López F, Rodríguez-Vázquez MA, Torres-Valle D, Mora-Rico K, Mora-Ríos FG, R.García‐Cortés L, Salcedo-Lozada P, Flores-Lujano J, Núñez-Enríquez JC, Bekker-Méndez VC, Mata-Rocha M, Rosas-Vargas H, Duarte-Rodríguez DA, Jiménez-Morales S, Hidalgo-Miranda A, López-Carrillo L, Mejía-Aranguré JM. Maternal diet in pregnancy and acute leukemia in infants: a case-control study in Mexico City. Front Oncol 2024; 13:1165323. [PMID: 38260836 PMCID: PMC10802844 DOI: 10.3389/fonc.2023.1165323] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Epidemiological studies around the world on acute leukemia (AL) and risk factors in infants are scarce. Infant AL has been proposed to originate in utero, which facilitates its study by establishing a short exposure time in pregnant women to environmental and dietary factors that could contribute to the risk of or protection against leukemia. We hypothesized that maternal diet during pregnancy may be an important factor involved in AL in offspring. Methods We conducted a hospital-based case-control study from 2010 to 2019 on maternal diet during pregnancy in nine high-specialty public hospitals of different health institutions that diagnose and offer treatment to children with AL in Mexico City. Cases (n=109) were children ≤24 months of age with de novo diagnosis of AL, and controls (n=252) were children obtained in hospitals from second-level medical care matched for age, sex, and health institution. Maternal diet during pregnancy was obtained by a semiquantitative food frequency questionnaire. Unconditional logistic regression models were used to assess the association between food groups and infant AL. Potential confounders were assessed by constructing directed acyclic graphs (DAGs) with Dagitty software in which adjusted options were identified for the construction of unconditional logistic regression models. Results Cases were slightly predominantly female (52.3%). The years of education of the mother in cases and controls was 0-9 on average, and those who reported smoking cigarettes and consuming alcohol during pregnancy did so at a low frequency. Regarding the mother's diet, the main findings were that the consumption of allium vegetables during pregnancy was inversely associated with AL for medium and high consumption (OR=0.26, 95% CI 0.14-0.46; P-trend< 0.001). In contrast, the high consumption of high-fat dairy products had a positive association with AL (OR=2.37, 95% CI 1.30-4.34; P-trend<0.001). No association was found between consumption of topoisomerase II inhibitor foods during pregnancy and AL. Conclusion The results suggest that maternal intake during pregnancy of allium vegetables, specifically garlic, is inversely associated with the development of AL in children ≤24 months old. On the other hand, consumption of high-fat dairy products is positively associated with AL in children ≤24 months old.
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Affiliation(s)
- María Luisa Pérez-Saldivar
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (Unidad Médica de Alta Especialidad (UMAE)) Hospital de Pediatría, Centro Médico Nacional (Centro Médico Nacional (CMN)) Siglo XXI, Instituto Mexicano del Seguro Social (Instituto Mexicano del Seguro Social (IMSS)), Mexico City, Mexico
| | | | - Nancy Núñez-Villegas
- Servicio de Hematología Pediátrica, Hospital General “Gaudencio González Garza”, Centro Médico Nacional (CMN) “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Arturo Fajardo-Gutiérrez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (Unidad Médica de Alta Especialidad (UMAE)) Hospital de Pediatría, Centro Médico Nacional (Centro Médico Nacional (CMN)) Siglo XXI, Instituto Mexicano del Seguro Social (Instituto Mexicano del Seguro Social (IMSS)), Mexico City, Mexico
| | - Aurora Medina-Sanson
- Departamento de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaria de Salud (Secretaría de Salud (SSA)), Mexico City, Mexico
| | - Elva Jiménez-Hernández
- Servicio de Oncología, Hospital Pediátrico Moctezuma, Secretaría de Salud de la Ciudad de México (Secretaría de Salud de la Ciudad de México (SSCDMX)), Mexico City, Mexico
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología, Unidad Médica de Alta Especialidad (UMAE) Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Norma López-Santiago
- Servicio de Hematología, Instituto Nacional de Pediatría (INP), Secretaría de Salud (SSA), Mexico City, Mexico
| | | | - Beatriz Cortés-Herrera
- Servicio de Hematología Pediátrica, Hospital General de México, Secretaría de Salud (SSA), Mexico City, Mexico
| | - Laura Elizabeth Merino-Pasaye
- Servicio de Hematología Pediátrica, Centro Médico Nacional (CMN)”20 de Noviembre”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE)), Mexico City, Mexico
| | - Raquel Amador-Sánchez
- Servicio de Hematología Pediátrica, HGR No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Luis Ramiro García-López
- Servicio de Pediatría, Hospital Pediátrico de Tacubaya, Secretaría de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | - Héctor Pérez-Lorenzana
- Servicio de Cirugía Pediátrica, Hospital General “Gaudencio González Garza”, Centro Médico Nacional (CMN) “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Pedro Francisco Román-Zepeda
- Servicio de Cirugía Pediátrica, Hospital General Regional (HGR) No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Alejandro Castañeda-Echevarría
- Servicio de Pediatría, Hospital General de Zona Regional (HGZR) No. 25 Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - María Guadalupe López-Caballero
- Coordinación Clínica y Pediatría, Hospital Pediátrico de Coyoacán, Secretaría de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | - Sofía Irene Martínez-Silva
- Hospital Pediátrico de Iztapalapa, Secretaría de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | - Juan Rivera-González
- Hospital General Dr. “Gustavo Baz Prada”, Instituto de Salud del Estado de México (ISEM), Estado de México, Mexico
| | - Jorge Granados-Kraulles
- Coordinación Clínica y Pediatría del Hospital General de Zona 76 Instituto Mexicano del Seguro Social (IMSS), Estado de México, Mexico
| | - Jesús Flores-Botello
- Coordinación Clínica y Pediatría, Hospital General “La Perla” ISEM, Estado de México, Mexico
| | - Francisco Medrano-López
- Coordinación Clínica y Pediatría, HGR No. 72 “Dr. Vicente Santos Guajardo”, Instituto Mexicano del Seguro Social (IMSS), Estado de México, Mexico
| | - María Adriana Rodríguez-Vázquez
- Coordinación Clínica y Pediatría del Hospital General de Zona 68, Instituto Mexicano del Seguro Social (IMSS), Estado de México, Mexico
| | - Delfino Torres-Valle
- Coordinación Clínica y Pediatría del Hospital General de Zona 71, Instituto Mexicano del Seguro Social (IMSS), Estado de México, Mexico
| | - Karina Mora-Rico
- Servicio de Cirugía Pediátrica, HGR 1° Octubre, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Félix G. Mora-Ríos
- Cirugía Pediátrica del Hospital Regional “General Ignacio Zaragoza”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Luis R.García‐Cortés
- Delegación Regional Estado de México Oriente, Instituto Mexicano del Seguro Social (IMSS), Estado de México, Mexico
| | | | - Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (Unidad Médica de Alta Especialidad (UMAE)) Hospital de Pediatría, Centro Médico Nacional (Centro Médico Nacional (CMN)) Siglo XXI, Instituto Mexicano del Seguro Social (Instituto Mexicano del Seguro Social (IMSS)), Mexico City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (Unidad Médica de Alta Especialidad (UMAE)) Hospital de Pediatría, Centro Médico Nacional (Centro Médico Nacional (CMN)) Siglo XXI, Instituto Mexicano del Seguro Social (Instituto Mexicano del Seguro Social (IMSS)), Mexico City, Mexico
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología “Dr. Daniel Méndez Hernández”, Centro Médico Nacional (CMN) “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Minerva Mata-Rocha
- Laboratorio de Biología Molecular de las Leucemias, Unidad de Investigación en Genética Humana, Unidad Médica de Alta Especialidad (UMAE), Hospital de Pediatría, Centro Médico Nacional (CMN) “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- Laboratorio de Genética, Unidad Médica de Alta Especialidad (Unidad Médica de Alta Especialidad (UMAE)) Hospital de Pediatría, Centro Médico Nacional (Centro Médico Nacional (CMN)) Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - David Aldebarán Duarte-Rodríguez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad (Unidad Médica de Alta Especialidad (UMAE)) Hospital de Pediatría, Centro Médico Nacional (Centro Médico Nacional (CMN)) Siglo XXI, Instituto Mexicano del Seguro Social (Instituto Mexicano del Seguro Social (IMSS)), Mexico City, Mexico
| | - Silvia Jiménez-Morales
- Laboratorio de Innovación y Medicina de Precisión, Núcleo A. Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Alfredo Hidalgo-Miranda
- Laboratorio de Innovación y Medicina de Precisión, Núcleo A. Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | | | - Juan Manuel Mejía-Aranguré
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Laboratorio Genómica Funcional del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
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Faulk KE, Kairalla JA, Dreyer ZE, Carroll AJ, Heerema NA, Devidas M, Carroll WL, Raetz EA, Loh ML, Hunger SP, Borowitz M, Wang C, Guest E, Brown PA. Minimal residual disease predicts outcomes in KMT2A-rearranged but not KMT2A-germline infant acute lymphoblastic leukemia: Report from Children's Oncology Group study AALL0631. Pediatr Blood Cancer 2023; 70:e30467. [PMID: 37259259 PMCID: PMC10687300 DOI: 10.1002/pbc.30467] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
We measured minimal residual disease (MRD) by multiparameter flow cytometry at three time points (TP) in 117 infants with KMT2A (lysine [K]-specific methyltransferase 2A)-rearranged and 58 with KMT2A-germline acute lymphoblastic leukemia (ALL) on Children's Oncology Group AALL0631 study. For KMT2A-rearranged patients, 3-year event-free survival (EFS) by MRD-positive (≥0.01%) versus MRD-negative (<0.01%) was: TP1: 25% (±6%) versus 49% (±7%; p = .0009); TP2: 21% (±8%) versus 47% (±7%; p < .0001); and TP3: 22% (±14%) versus 51% (±6%; p = .0178). For KMT2A-germline patients, 3-year EFS was: TP1: 88% (±12%) versus 87% (±5%; p = .73); TP2: 100% versus 88% (±5%; p = .24); and TP3: 100% versus 87% (±5%; p = .53). MRD was a strong independent outcome predictor in KMT2A-rearranged, but not KMT2A-germline infant ALL.
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Affiliation(s)
- Kelly E. Faulk
- University of Colorado Anschutz Medical Campus, Pediatric Oncology, Denver, CO, USA
| | | | - ZoAnn E. Dreyer
- Texas Children’s Hospital, Pediatric Oncology, Houston, TX, USA
| | | | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - William L. Carroll
- Perlmutter Cancer Center, and the New York University Grossman School of Medicine, Division of Pediatric Hematology/Oncology, New York, NY, USA
| | - Elizabeth A. Raetz
- Perlmutter Cancer Center, and the New York University Grossman School of Medicine, Division of Pediatric Hematology/Oncology, New York, NY, USA
| | - Mignon L. Loh
- University of Washington, Pediatric Oncology, Seattle, WA, USA
| | - Stephen P. Hunger
- Division of Oncology and the Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Cindy Wang
- University of Florida, Biostatistics, Gainesville, FL, USA
| | - Erin Guest
- Division of Hematology, Oncology, Blood and Marrow Transplantation, Children’s Mercy Kansas City, Kansas City, MO, USA
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Ochoa-Fernández B, Galán-Gómez V, Guerra-García P, Sanromán S, Martínez I, Bueno D, Mozo Y, Sisinni L, Losantos I, González B, Pérez-Martínez A. Younger age and induction failure predict outcomes in infant leukemia: 30 years of experience in a tertiary center. Front Pediatr 2023; 11:1166176. [PMID: 37325355 PMCID: PMC10263122 DOI: 10.3389/fped.2023.1166176] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives This study aimed to evaluate the characteristics and outcomes of infant patients with leukemia. Methods A retrospective analysis was conducted in a cohort of 39 patients diagnosed with infant leukemia from 1990 to 2020 who underwent treatment at the pediatric hemato-oncology department of a tertiary hospital in Madrid, Spain. Results Of the 588 diagnosed cases of childhood leukemia, 39 (6.6%) cases were infant leukemia. The 5-year event-free survival and the 5-year overall survival were 43.6% (SE 4.1) and 46.5% (SD 24.08), respectively. In a univariate analysis, a younger age at diagnosis was associated with poorer outcomes (p = 0.027), as was induction failure (p = 0.0024). Patients treated with hematopoietic stem cell transplantation had better outcomes than non-transplanted patients (p = 0.001); however, the group comparisons that exclude patients who were unable to undergo transplantation due to refractoriness/relapse or death during treatment showed no significant differences. Conclusions The main risk factors that affected survival in our study were an age younger than 6 months and a poor response to induction therapy. It is important to identify poor prognostic factors in this population in order to seek different approaches that could improve outcomes.
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Affiliation(s)
| | - Víctor Galán-Gómez
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Pilar Guerra-García
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
| | - Sonsoles Sanromán
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
| | - Isabel Martínez
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - David Bueno
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
| | - Yasmina Mozo
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Luisa Sisinni
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Itsaso Losantos
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Berta González
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
| | - Antonio Pérez-Martínez
- Pediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
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Xiao L, Karsa M, Ronca E, Bongers A, Kosciolek A, El-Ayoubi A, Revalde JL, Seneviratne JA, Cheung BB, Cheung LC, Kotecha RS, Newbold A, Bjelosevic S, Arndt GM, Lock RB, Johnstone RW, Gudkov AV, Gurova KV, Haber M, Norris MD, Henderson MJ, Somers K. The Combination of Curaxin CBL0137 and Histone Deacetylase Inhibitor Panobinostat Delays KMT2A-Rearranged Leukemia Progression. Front Oncol 2022; 12:863329. [PMID: 35677155 PMCID: PMC9168530 DOI: 10.3389/fonc.2022.863329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Rearrangements of the Mixed Lineage Leukemia (MLL/KMT2A) gene are present in approximately 10% of acute leukemias and characteristically define disease with poor outcome. Driven by the unmet need to develop better therapies for KMT2A-rearranged leukemia, we previously discovered that the novel anti-cancer agent, curaxin CBL0137, induces decondensation of chromatin in cancer cells, delays leukemia progression and potentiates standard of care chemotherapies in preclinical KMT2A-rearranged leukemia models. Based on the promising potential of histone deacetylase (HDAC) inhibitors as targeted anti-cancer agents for KMT2A-rearranged leukemia and the fact that HDAC inhibitors also decondense chromatin via an alternate mechanism, we investigated whether CBL0137 could potentiate the efficacy of the HDAC inhibitor panobinostat in KMT2A-rearranged leukemia models. The combination of CBL0137 and panobinostat rapidly killed KMT2A-rearranged leukemia cells by apoptosis and significantly delayed leukemia progression and extended survival in an aggressive model of MLL-AF9 (KMT2A:MLLT3) driven murine acute myeloid leukemia. The drug combination also exerted a strong anti-leukemia response in a rapidly progressing xenograft model derived from an infant with KMT2A-rearranged acute lymphoblastic leukemia, significantly extending survival compared to either monotherapy. The therapeutic enhancement between CBL0137 and panobinostat in KMT2A-r leukemia cells does not appear to be mediated through cooperative effects of the drugs on KMT2A rearrangement-associated histone modifications. Our data has identified the CBL0137/panobinostat combination as a potential novel targeted therapeutic approach to improve outcome for KMT2A-rearranged leukemia.
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Affiliation(s)
- Lin Xiao
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Emma Ronca
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Angelika Bongers
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Angelika Kosciolek
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Ali El-Ayoubi
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia
| | - Jezrael L Revalde
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Janith A Seneviratne
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Belamy B Cheung
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Laurence C Cheung
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia.,Curtin Medical School, Curtin University, Perth, WA, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Rishi S Kotecha
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia.,Curtin Medical School, Curtin University, Perth, WA, Australia.,Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Andrea Newbold
- Gene Regulation Laboratory, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Stefan Bjelosevic
- Gene Regulation Laboratory, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg M Arndt
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.,Australian Cancer Research Foundation (ACRF) Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Ricky W Johnstone
- Gene Regulation Laboratory, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrei V Gudkov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, United States
| | - Katerina V Gurova
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, United States
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.,University of New South Wales Centre for Childhood Cancer Research, Sydney, NSW, Australia
| | - Michelle J Henderson
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Institute, University of New South Wales, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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7
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Nakajima K, Kubota H, Kato I, Isobe K, Ueno H, Kozuki K, Tanaka K, Kawabata N, Mikami T, Tamefusa K, Nishiuchi R, Saida S, Umeda K, Hiramatsu H, Adachi S, Takita J. PAX5 alterations in an infant case of KMT2A-rearranged leukemia with lineage switch. Cancer Sci 2022; 113:2472-2476. [PMID: 35467057 PMCID: PMC9277256 DOI: 10.1111/cas.15380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022] Open
Abstract
Lineage switch is a rare event at leukemic relapse. While mostly known to occur in KMT2A-rearranged infant leukemia, the underlying mechanism is yet to be depicted. This case report describes a female infant who achieved remission of KMT2A-MLLT3-rearranged acute monocytic leukemia, but six months thereafter, relapsed as KMT2A-MLLT3-rearranged acute lymphocytic leukemia. Whole exome sequencing of the bone marrow obtained pre-post lineage switch revealed two somatic mutations of PAX5 in the relapse sample. These two PAX5 alterations were suggested to be loss of function, thus to have played the driver role in the lineage switch from AML to ALL.
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Affiliation(s)
- Koji Nakajima
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirohito Kubota
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Kato
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyotaka Isobe
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroo Ueno
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kagehiro Kozuki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kuniaki Tanaka
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Kawabata
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mikami
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Tamefusa
- Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan
| | - Ritsuo Nishiuchi
- Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan
| | - Satoshi Saida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsutsugu Umeda
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Souichi Adachi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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8
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Symeonidou V, Jakobczyk H, Bashanfer S, Malouf C, Fotopoulou F, Kotecha RS, Anderson RA, Finch AJ, Ottersbach K. Defining the fetal origin of MLL-AF4 infant leukemia highlights specific fatty acid requirements. Cell Rep 2021; 37:109900. [PMID: 34706236 PMCID: PMC8567312 DOI: 10.1016/j.celrep.2021.109900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/01/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022] Open
Abstract
Infant MLL-AF4-driven acute lymphoblastic leukemia (ALL) is a devastating disease with dismal prognosis. A lack of understanding of the unique biology of this disease, particularly its prenatal origin, has hindered improvement of survival. We perform multiple RNA sequencing experiments on fetal, neonatal, and adult hematopoietic stem and progenitor cells from human and mouse. This allows definition of a conserved fetal transcriptional signature characterized by a prominent proliferative and oncogenic nature that persists in infant ALL blasts. From this signature, we identify a number of genes in functional validation studies that are critical for survival of MLL-AF4+ ALL cells. Of particular interest are PLK1 because of the readily available inhibitor and ELOVL1, which highlights altered fatty acid metabolism as a feature of infant ALL. We identify which aspects of the disease are residues of its fetal origin and potential disease vulnerabilities.
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Affiliation(s)
- Vasiliki Symeonidou
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Hélène Jakobczyk
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Salem Bashanfer
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Camille Malouf
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Foteini Fotopoulou
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Rishi S Kotecha
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Andrew J Finch
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Katrin Ottersbach
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK.
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9
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Ibrahimova A, Winestone LE, Miller TP, Kettler K, Seif AE, Huang YS, Elgarten CW, Myers RM, Fisher BT, Aplenc R, Getz KD. Presentation acuity, induction mortality, and resource utilization in infants with acute leukemia. Pediatr Blood Cancer 2021; 68:e28940. [PMID: 33704911 PMCID: PMC8283996 DOI: 10.1002/pbc.28940] [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] [Received: 05/14/2020] [Revised: 12/28/2020] [Accepted: 01/11/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Treatment of infants with acute leukemia remains challenging, especially for acute lymphocytic leukemia (ALL). Infants have shown markedly higher rates of induction mortality compared with noninfants. There are limited data on presentation acuity and supportive care utilization in this age group. METHODS In retrospective analyses of patients treated for new onset ALL or acute myeloid leukemia (AML) at pediatric hospitals contributing to the Pediatric Health Information System, we compared presentation acuity, induction mortality, and resource utilization in infants relative to noninfants less than 10 years at diagnosis. RESULTS Analyses included 10 359 children with ALL (405 infants, 9954 noninfants) and 871 AML (189 infants, 682 noninfants). Infants were more likely to present with multisystem organ failure compared to noninfants for both ALL (12% and 1%, PR = 10.8, 95% CI: 7.4, 15.7) and AML (6% vs. 3%; PR = 2.0, 95% CI: 1.0, 3.7). Infants with ALL had higher induction mortality compared to noninfants, even after accounting for differences in anthracycline exposure and presentation acuity (2.7% vs. 0.5%, HR = 2.1, 95% CI: 1.0, 4.8). Conversely, infants and noninfants with AML had similar rates of induction mortality (3.2% vs. 2.1%, HR = 1.2, 95% CI: 0.3, 3.9), which were comparable to rates among infants with ALL. Infants with ALL and AML had greater requirements for blood products, diuretics, supplemental oxygen, and ventilation during induction relative to noninfants. CONCLUSIONS Infants with leukemia present with higher acuity compared with noninfants. Induction mortality and supportive care requirements for infants with ALL were similar to all children with AML, and significantly higher than those for noninfants with ALL.
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Affiliation(s)
- Azada Ibrahimova
- Department of Pediatrics and Adolescent Medicine, Einstein Healthcare Network Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lena E. Winestone
- Division of AIBMT, Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco, California, USA
| | - Tamara P. Miller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kyle Kettler
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Alix E. Seif
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yuan-Shung Huang
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Caitlin W. Elgarten
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Regina M. Myers
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian T. Fisher
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA,Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Aplenc
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kelly D. Getz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Quessada J, Cuccuini W, Saultier P, Loosveld M, Harrison CJ, Lafage-Pochitaloff M. Cytogenetics of Pediatric Acute Myeloid Leukemia: A Review of the Current Knowledge. Genes (Basel) 2021; 12:genes12060924. [PMID: 34204358 PMCID: PMC8233729 DOI: 10.3390/genes12060924] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/04/2023] Open
Abstract
Pediatric acute myeloid leukemia is a rare and heterogeneous disease in relation to morphology, immunophenotyping, germline and somatic cytogenetic and genetic abnormalities. Over recent decades, outcomes have greatly improved, although survival rates remain around 70% and the relapse rate is high, at around 30%. Cytogenetics is an important factor for diagnosis and indication of prognosis. The main cytogenetic abnormalities are referenced in the current WHO classification of acute myeloid leukemia, where there is an indication for risk-adapted therapy. The aim of this article is to provide an updated review of cytogenetics in pediatric AML, describing well-known WHO entities, as well as new subgroups and germline mutations with therapeutic implications. We describe the main chromosomal abnormalities, their frequency according to age and AML subtypes, and their prognostic relevance within current therapeutic protocols. We focus on de novo AML and on cytogenetic diagnosis, including the practical difficulties encountered, based on the most recent hematological and cytogenetic recommendations.
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Affiliation(s)
- Julie Quessada
- Hematological Cytogenetics Laboratory, Timone Children’s Hospital, Assistance Publique-Hôpitaux de Marseille (APHM), Faculté de Médecine, Aix Marseille University, 13005 Marseille, France;
- Aix Marseille University, CNRS, INSERM, CIML, 13009 Marseille, France;
| | - Wendy Cuccuini
- Hematological Cytogenetics Laboratory, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris (APHP), 75010 Paris, France;
- Groupe Francophone de Cytogénétique Hématologique (GFCH), 1 Avenue Claude Vellefaux, 75475 Paris, France
| | - Paul Saultier
- APHM, La Timone Children’s Hospital Department of Pediatric Hematology and Oncology, 13005 Marseille, France;
- Faculté de Médecine, Aix Marseille University, INSERM, INRAe, C2VN, 13005 Marseille, France
| | - Marie Loosveld
- Aix Marseille University, CNRS, INSERM, CIML, 13009 Marseille, France;
- Hematology Laboratory, Timone Hospital, Assistance Publique-Hôpitaux de Marseille (APHM), 13005 Marseille, France
| | - Christine J. Harrison
- Leukaemia Research Cytogenetics Group Translational and Clinical Research Institute, Newcastle University Centre for Cancer Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Marina Lafage-Pochitaloff
- Hematological Cytogenetics Laboratory, Timone Children’s Hospital, Assistance Publique-Hôpitaux de Marseille (APHM), Faculté de Médecine, Aix Marseille University, 13005 Marseille, France;
- Groupe Francophone de Cytogénétique Hématologique (GFCH), 1 Avenue Claude Vellefaux, 75475 Paris, France
- Correspondence: ; Tel.: +33-4-91-38-76-41
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11
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Pennella CL, Deu MA, Rossi JG, Baialardo EM, Alonso CN, Rubio P, Guitter MR, La Rosa CGS, Alfaro EM, Zubizarreta PA, Felice MS. No benefit of Interfant protocols compared to BFM-based protocols for infants with acute lymphoblastic leukemia. Results from an institution in Argentina. Pediatr Blood Cancer 2020; 67:e28624. [PMID: 32729239 DOI: 10.1002/pbc.28624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/05/2020] [Accepted: 07/15/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Infant acute lymphoblastic leukemia (ALL) is an infrequent disease characterized by clinical and biological features related to poor prognosis. Adapted therapies were designed without a clear consensus regarding the best treatment options. We aimed to compare the outcome between infant ALL cases receiving Interfant versus BFM-based protocols. PROCEDURE This is a retrospective observational study. From April 1990 to June 2018, infant ALL cases were enrolled in one of the five consecutive treatment protocols. Clinical, demographic, and biological features and outcome were evaluated. A comparative analysis was performed between Interfant protocols and BFM-based protocols. RESULTS During the studied period, 1913 ALL patients were admitted and 116 (6%) were infants. Treatment administered was: ALL-BFM'90 (n = 16), 1-ALL96-BFM/HPG (n = 7), Interfant-99 (n = 39), Interfant-06 (n = 35), and ALLIC-BFM'2009 (n = 19). The 5-year event-free survival probability (EFSp) was 31.9(standard error [SE] 4.6)% for the entire population, with a significant difference among risk groups according to Interfant-06 criteria (P = .0029). KMT2A-rearrangement status was the strongest prognostic factor (P = .048), independently of the protocol strategy. The median time for relapse was 24.1 months for patients with minimal residual disease (MRD)-negative versus 11.5 months for those with MRD-positive (P = .0386). EFSp and cumulative relapse risk probability (CRRp) were similar. Interfant protocols showed comparable induction (8.1% vs 7.1%, P = .852) and complete remission mortality (21.6% vs 28.6%, P = .438), failing to reduce the relapse rate (48.5% vs 30.7%, P = .149). CONCLUSIONS Interfant protocols and BFM-based protocols presented comparable results. The risk group stratification proposed by Interfant-06 was validated by our results, and MRD seems useful to identify patients with an increased risk of early relapse.
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Affiliation(s)
- Carla L Pennella
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - María A Deu
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Jorge G Rossi
- Department of Immunology and Rheumatology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Edgardo M Baialardo
- Department of Genetics, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Cristina N Alonso
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Patricia Rubio
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Myriam R Guitter
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Cristian G Sánchez La Rosa
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Elizabeth M Alfaro
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Pedro A Zubizarreta
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - María S Felice
- Department of Hematology-Oncology, Hospital de Pediatría S.A.M.I.C Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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12
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Yaman-Bajin İ, Aytaç S, Kuşkonmaz B, Uçkan-Çetinkaya D, Ünal Ş, Gümrük F, Çetin M. Infant lymphoblastic leukemia: a single centers 10 year experience. Turk J Pediatr 2020; 61:325-329. [PMID: 31916708 DOI: 10.24953/turkjped.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Yaman-Bajin İ, Aytaç S, Kuşkonmaz B, Uçkan-Çetinkaya D, Ünal Ş, Gümrük F, Çetin M. Infant lymphoblastic leukemia: a single centers 10 year experience. Turk J Pediatr 2019; 61: 325-329. Infant acute lymphoblastic leukemia (ALL) is a rare disease and consists of 4-5% of all childhood ALL. Despite improved survival rates in childhood ALL, infants with ALL have a worse prognosis. We aimed to evaluate the clinical features and treatment outcomes of our patients diagnosed with infant ALL at Hacettepe University, Pediatric Hematology Department between 1 January 2008 and 1 January 2018 retrospectively. There were 13 patients with a median age of 7 months. Three of the patients were triplets born from a spontaneous monozygotic triplet pregnancy. Relapse were observed in 4 patients. Hematopoietic stem cell transplantation (HSCT) was performed for five patients. Relapse after HSCT was observed in 3 patients. After a median follow-up period of 18 months, 6 patients (45%) (3 after HSCT and 3 who only received chemotherapy) were alive and in remission. Prognosis of infant ALL is poor in that only half of the patients survive. Our results suggest that bone marrow transplantation seems to be a good and efficient choice of treatment for selected patients. However, there is still a big issue to decide which patient should undergo transplantation and more studies are needed to reevaluate the eligibility criteria for HSCT in this group of patients.
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Affiliation(s)
- İnci Yaman-Bajin
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selin Aytaç
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Barış Kuşkonmaz
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Duygu Uçkan-Çetinkaya
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şule Ünal
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Gümrük
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mualla Çetin
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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13
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Blackburn PR, Smadbeck JB, Znoyko I, Webley MR, Pitel BA, Vasmatzis G, Xu X, Greipp PT, Hoppman NL, Ketterling RP, Baughn LB, Lindsey KG, Schandl CA, Wolff DJ, Peterson JF. Cryptic and atypical KMT2A-USP2 and KMT2A-USP8 rearrangements identified by mate pair sequencing in infant and childhood leukemia. Genes Chromosomes Cancer 2020; 59:422-427. [PMID: 32196814 DOI: 10.1002/gcc.22842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 11/07/2022] Open
Abstract
Infant leukemias are a rare group of neoplasms that are clinically and biologically distinct from their pediatric and adult counterparts. Unlike leukemia in older children where survival rates are generally favorable, infants with leukemia have a 5-year event-free survival rate of <50%. The majority of infant leukemias are characterized by KMT2A (MLL) rearrangements (~70 to 80% in acute lymphoblastic leukemia), which appear to be drivers of early leukemogenesis. In this report, we describe three cases: a 9-month-old female infant with B-acute lymphoblastic leukemia (B-ALL), an 8-month-old female presenting with B/myeloid mixed phenotype acute leukemia (MPAL), and a 16-month-old male with B-ALL. The first case had a normal karyotype and B-ALL FISH results consistent with an atypical KMT2A rearrangement. The second case had trisomy 10 as the sole chromosomal abnormality and a normal KMT2A FISH result. Case 3 had trisomy 8 and a t(11;15)(q23;q21), an atypical KMT2A rearrangement by FISH studies, and a focal deletion of 15q with a breakpoint within the USP8 gene by chromosomal microarray. Mate pair sequencing was performed on all three cases and identified a KMT2A-USP2 rearrangement (cases 1 and 2) or a KMT2A-USP8 rearrangement (case 3). These recently characterized KMT2A fusions have been described exclusively in infant and pediatric leukemia cases where the incidence varies vary according to leukemia subtype, are considered high-risk, with a high incidence of central nervous system involvement, poor response to initial prednisone treatment, and poor event free survival. Additionally, approximately half of cases are unable to be resolved using standard cytogenetic approaches and are likely under recognized. Therefore, targeted molecular approaches are suggested in genetically unresolved infant leukemia cases to characterize these prognostically relevant clones.
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Affiliation(s)
- Patrick R Blackburn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - James B Smadbeck
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, Minnesota, USA
| | - Iya Znoyko
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Matthew R Webley
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Beth A Pitel
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - George Vasmatzis
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, Minnesota, USA
| | - Xinjie Xu
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole L Hoppman
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn G Lindsey
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia A Schandl
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daynna J Wolff
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Abstract
Although treatment strategies for pediatric leukemia have improved overall survival rates in the recent past, relapse rates in certain subgroups such as infant leukemia remain unacceptably high. Despite undergoing extensive chemotherapy designed to target the rapidly proliferating leukemia cells, many of these children experience relapse. In refractory leukemia, the existence of cell populations with stemness characteristics, termed leukemia stem cells (LSCs), which remain quiescent and subsequently replenish the blast population, has been described. A significant body of evidence exists, derived largely from xenograft models of adult acute myeloid leukemia, to support the idea that LSCs may play a fundamental role in refractory disease. In addition, clinical studies have also linked LSCs with increased minimal residual disease, higher relapse rate, and decreased survival rates in these patients. Recently, a number of reports have addressed effective ways to utilize new-generation genomic sequencing and transcriptomic analyses to identify targeted therapeutic agents aimed at LSCs, while sparing normal hematopoietic stem cells. These data underscore the value of timely translation of knowledge from adult studies to the unique molecular and physiological characteristics seen in pediatric leukemia. We aim to summarize this article in the rapidly expanding field of stem cell biology in hematopoietic malignancies, focusing particularly on relevant preclinical models and novel targeted therapeutics, and their applicability to childhood leukemia.
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Affiliation(s)
| | - Aru Narendran
- Division of Pediatric Hematology, Oncology and Transplant, POETIC Laboratory for Novel Therapeutics Discovery in Pediatric Oncology, Alberta Children's Hospital, Calgary, Canada
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15
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Moritani K, Tauchi H, Ochi F, Yonezawa S, Takemoto K, Eguchi-Ishimae M, Eguchi M, Ishii E, Nagai K. Prolonged adrenal insufficiency after high-dose glucocorticoid in infants with leukemia. Pediatr Hematol Oncol 2018; 35:355-361. [PMID: 30457427 DOI: 10.1080/08880018.2018.1539148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although outcomes for infant leukemia have improved recently, transient adrenal insufficiency is commonly observed during treatment, especially after glucocorticoid administration. We identified three infants with acute leukemia who suffered from prolonged adrenal insufficiency requiring long-term (from 15 to 66 months) hydrocortisone replacement. All infants showed life-threatening symptoms associated with adrenal crisis after viral infections or other stress. Severe and prolonged damage of hypothalamo-pituitary-adrenal (HPA) axis is likely to occur in early infants with leukemia, therefore routine tolerance testing to evaluate HPA axis and hydrocortisone replacement therapy are recommended for infants with leukemia to avoid life-threatening complications caused by adrenal crisis.
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Affiliation(s)
- Kyoko Moritani
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Hisamichi Tauchi
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Fumihiro Ochi
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Sachiko Yonezawa
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Koji Takemoto
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | | | - Mariko Eguchi
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Eiichi Ishii
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Kozo Nagai
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
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16
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Noailly Charny PA, Bleyzac N, Ohannessian R, Aubert E, Bertrand Y, Renard C. Increased Risk of Thrombosis Associated with Peripherally Inserted Central Catheters Compared with Conventional Central Venous Catheters in Children with Leukemia. J Pediatr 2018; 198:46-52. [PMID: 29709343 DOI: 10.1016/j.jpeds.2018.03.026] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/08/2018] [Accepted: 03/14/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To study the risk of catheter-associated thrombosis (CAT) between peripherally inserted central catheters (PICCs) and tunneled central venous catheters in children with leukemia. STUDY DESIGN We analyzed all PICCs and conventional tunneled catheters placed in patients aged <18 years and admitted to our institute for leukemia treatment between February 2008 and April 2014. Cases of symptomatic CAT were confirmed by ultrasound and treated with low-molecular-weight heparin. RESULTS During the study period, 157 PICCs and 138 conventional tunneled catheters were placed in 192 patients with leukemia. CAT incidence was 1.5% (n = 2) in the conventional tunneled catheter group and 10.2% (n = 16) in the PICC group. The OR for CAT occurrence after PICC vs conventional tunneled catheter placement was 5.6 (95% CI, 1.2-26.5). CONCLUSION Our results suggest that the use of PICCs in children with leukemia increases the risk of CAT in comparison with the use of conventional tunneled catheters. Further randomized controlled studies are needed to characterize this risk and to better define indications.
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Affiliation(s)
- Pierre-Amaël Noailly Charny
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France; University of Lyon Claude Bernard, Lyon, France.
| | - Nathalie Bleyzac
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | | | - Edouard Aubert
- Department of Anesthesia, Centre Léon Bérard, Lyon, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France; University of Lyon Claude Bernard, Lyon, France
| | - Cecile Renard
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France
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17
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Abstract
The mixed-lineage leukemia 1 (MLL1) gene (now renamed Lysine [K]-specific MethylTransferase 2A or KMT2A) on chromosome 11q23 is disrupted in a unique group of acute leukemias. More than 80 different partner genes in these fusions have been described, although the majority of leukemias result from MLL1 fusions with one of about six common partner genes. Approximately 10% of all leukemias harbor MLL1 translocations. Of these, two patient populations comprise the majority of cases: patients younger than 1 year of age at diagnosis (primarily acute lymphoblastic leukemias) and young- to-middle-aged adults (primarily acute myeloid leukemias). A much rarer subgroup of patients with MLL1 rearrangements develop leukemia that is attributable to prior treatment with certain chemotherapeutic agents-so-called therapy-related leukemias. In general, outcomes for all of these patients remain poor when compared to patients with non-MLL1 rearranged leukemias. In this review, we will discuss the normal biological roles of MLL1 and its fusion partners, how these roles are hypothesized to be dysregulated in the context of MLL1 rearrangements, and the clinical manifestations of this group of leukemias. We will go on to discuss the progress in clinical management and promising new avenues of research, which may lead to more effective targeted therapies for affected patients.
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Affiliation(s)
- Amanda C Winters
- Division of Pediatric Hematology/Oncology/BMT, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, CO , USA
| | - Kathrin M Bernt
- Division of Pediatric Hematology/Oncology/BMT, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, CO , USA
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18
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Geerlinks AV, Issekutz T, Wahlstrom JT, Sullivan KE, Cowan MJ, Dvorak CC, Fernandez CV. Severe, persistent, and fatal T-cell immunodeficiency following therapy for infantile leukemia. Pediatr Blood Cancer 2016; 63:2046-9. [PMID: 27354010 PMCID: PMC7168093 DOI: 10.1002/pbc.26108] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/16/2016] [Accepted: 05/26/2016] [Indexed: 01/31/2023]
Abstract
We describe five cases of children who completed chemotherapy for infantile acute lymphoblastic leukemia (ALL) and soon after were diagnosed with severe T-cell, non-HIV immunodeficiency, with varying B-cell and NK-cell depletion. There was near absence of CD3(+) , CD4(+) , and CD8(+) cells. All patients developed multiple, primarily opportunistic infections. Unfortunately, four patients died, although one was successfully treated by hematopoietic stem cell transplantation. These immunodeficiencies appeared to be secondary to intensive infant ALL chemotherapy. Our report highlights the importance of the early consideration of this life-threatening immune complication in patients who received chemotherapy for infantile ALL.
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Affiliation(s)
- Ashley V. Geerlinks
- Department of PediatricsIWK Health Centre, Dalhousie UniversityHalifax, NSCanada
| | - Thomas Issekutz
- Department of PediatricsIWK Health Centre, Dalhousie UniversityHalifax, NSCanada
| | - Justin T. Wahlstrom
- Department of PediatricsBenioff Children's Hospital, University of California San FranciscoSan Francisco, CA
| | - Kathleen E. Sullivan
- Department of PediatricsChildren's Hospital of Philadelphia, University of Pennsylvania Perelman School of MedicinePhiladelphiaCA
| | - Morton J. Cowan
- Department of PediatricsBenioff Children's Hospital, University of California San FranciscoSan Francisco, CA
| | - Christopher C. Dvorak
- Department of PediatricsBenioff Children's Hospital, University of California San FranciscoSan Francisco, CA
| | - Conrad V. Fernandez
- Department of PediatricsIWK Health Centre, Dalhousie UniversityHalifax, NSCanada
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19
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Nakashima MO, Shetty S, Chicka M, Flagg A, Eng C, Cotta CV. Transient abnormal myelopoiesis of a newborn not associated with chromosome 21 abnormalities or GATA1 mutations. Pediatr Blood Cancer 2015; 62:353-355. [PMID: 25175265 DOI: 10.1002/pbc.25226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/25/2014] [Indexed: 11/06/2022]
Abstract
Transient abnormal myelopoiesis (TAM) is a disorder of Down syndrome newborns characterized by megakaryocytic blasts indistinguishable from acute myeloid leukemia (AML), which undergoes spontaneous remission. Acquired GATA1 mutations are present in blasts of both TAM and the subsequent AML which sometimes develops. We present a unique case of a newborn with leukemic megakaryoblasts indistinguishable from those of TAM who had neither extra material from chromosome 21 in the germline or blasts, nor evidence of GATA1 mutations. These findings suggest there are other genetic abnormalities that can lead to TAM besides GATA1 mutation in the setting of trisomy 21. Pediatr Blood Cancer 2015;62:353-355. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Megan O Nakashima
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, 44195, Ohio
| | - Shashirekha Shetty
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, 44195, Ohio
| | | | - Aron Flagg
- Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charis Eng
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Claudiu V Cotta
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, 44195, Ohio
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20
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Ferreira JD, Couto AC, Pombo-de-Oliveira MS, Koifman S. In utero pesticide exposure and leukemia in Brazilian children < 2 years of age. Environ Health Perspect 2013; 121:269-75. [PMID: 23092909 PMCID: PMC3569673 DOI: 10.1289/ehp.1103942] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 10/22/2012] [Indexed: 05/02/2023]
Abstract
BACKGROUND An association between pesticide exposure and cancer has been suggested. Infant leukemia is a rare neoplasm and its association with maternal pesticide exposure has been poorly explored. OBJECTIVES We investigated the association between pesticide exposure during pregnancy and leukemia in children < 2 years of age. METHODS A hospital-based case-control study was carried out in 13 Brazilian states during 1999-2007. Mothers of 252 cases and those of 423 controls were interviewed. Information on pesticide exposures 3 months before pregnancy, throughout pregnancy, and during breastfeeding was obtained. Unconditional logistic regression was used to estimate adjusted odds ratios (aORs) for associations between pesticide exposures and leukemia. RESULTS Associations with ever use of pesticides during pregnancy were observed for acute lymphoid leukemia (ALL) (aOR = 2.10; 95% CI: 1.14, 3.86) and acute myeloid leukemia (AML) (aOR = 5.01; 95% CI: 1.97, 12.7) in children 0-11 months of age, and with ALL (aOR = 1.88; 95% CI: 1.05, 5.23) at 12-23 months of age. According to reported maternal exposure to permethrin, higher risk estimates were verified for children 0-11 months of age (aOR = 2.47; 95% CI: 1.17, 5.25 for ALL; and aOR = 7.28; 95% CI: 2.60, 20.38 for AML). Maternal pesticide exposure related to agricultural activities showed an aOR of 5.25 (95% CI: 1.83, 15.08) for ALL, and an aOR of 7.56 (95% CI: 1.83, 31.23) for AML. CONCLUSIONS These results support the hypothesis that pesticide exposure during pregnancy may be involved in the etiology of acute leukemia in children < 2 years of age.
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Affiliation(s)
- Jeniffer Dantas Ferreira
- Environment and Public Health Post-graduation Program, National School of Public Health, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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21
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Ferreira JD, Couto AC, Pombo-de-Oliveira MS, Koifman S. Pregnancy, maternal tobacco smoking, and early age leukemia in Brazil. Front Oncol 2012; 2:151. [PMID: 23162789 PMCID: PMC3494108 DOI: 10.3389/fonc.2012.00151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/06/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Cigarette smoking has been associated with acute myeloid leukemia (AML) but hypothesis on the association between maternal smoking during pregnancy and childhood leukemia remains unclear. OBJECTIVES To investigate the association between maternal exposure to tobacco smoking during pregnancy and early age (<2 year) leukemia (EAL). METHODS A hospital-based multicenter case-control study aiming to explore EAL risk factors was carried out in Brazil during 1999-2007. Data were collected by direct interview with the biological mothers using a standardized questionnaire. The present study included 675 children (193 acute lymphoid leukemia - ALL, 59 AML and 423 controls), being the latter age frequency matched and paired by area of residence with the cases. Unconditional logistic regression was performed, and odds ratios (OR) on the association between tobacco smoking (3 months before pregnancy, during pregnancy, and 3 months after delivery) and EAL were ascertained after adjustment for selected variables (maternal age at birth and education, birth weight, infant skin color, and oral contraceptives use during pregnancy). RESULTS Smoking was reported by 17.5% of case mothers and 20.6% of controls. Among women who reported to have smoked 20 or more cigarettes during the index pregnancy, an adjusted OR = 5.28 (95% CI 1.40-19.95) for ALL was observed. Heavy smoking during breastfeeding yielded an adjusted risk estimate for ALL, OR = 7.78 (95% CI 1.33-45.5). No dose-response effect was observed according to smoking exposure during pregnancy and EAL. An association between secondhand smoking during pregnancy or breastfeeding was not observed. CONCLUSION An association between maternal smoking and EAL in the offspring was restricted to women who have reported an intense exposure to tobacco smoke during pregnancy and breastfeeding.
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Affiliation(s)
- Jeniffer Dantas Ferreira
- Environment and Public Health Post-graduation Program, National School of Public Health, Oswaldo Cruz FoundationRio de Janeiro, Brazil
| | - Arnaldo Cézar Couto
- Environment and Public Health Post-graduation Program, National School of Public Health, Oswaldo Cruz FoundationRio de Janeiro, Brazil
| | - Maria S. Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer/Rio de JaneiroRio de Janeiro, Brazil
| | - Sergio Koifman
- Environment and Public Health Post-graduation Program, National School of Public Health, Oswaldo Cruz FoundationRio de Janeiro, Brazil
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22
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Abstract
BACKGROUND Leukemia in infants is rare and has not been well studied apart from leukemia in older children. Differences in survival and the molecular characteristics of leukemia in infants versus older children suggest a distinct etiology, likely involving prenatal factors. PROCEDURE We examined the association between eight categories of maternally reported congenital abnormalities (CAs) (cleft lip or palate, spina bifida or other spinal defect, large or multiple birthmarks, other chromosomal abnormalities, small head or microcephaly, rib abnormalities, urogenital abnormalities, and other) and infant leukemia in a case-control study. The study included 443 cases diagnosed at <1 year of age at a Children's Oncology Group Institution in the United States or Canada from 1996 to 2006 and 324 controls. Controls were recruited from the cases' geographic area either by random digit dialing (1999-2002) or through birth certificates (2003-2008) and were frequency-matched to cases on birth year. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression after adjustment for birth year and a measure of follow-up time to account for differences in the CA observation period. RESULTS No statistically significant associations were observed between infant leukemia and any CA (OR = 1.2; 95% CI: 0.8-1.9), birthmarks (OR = 1.4; 95% CI: 0.7-2.5), urogenital abnormalities (OR = 0.7; 95% CI: 0.2-2.0), or other CA (OR = 1.4; 95% CI: 0.7-2.8). Results were similar for acute lymphoblastic and myeloid leukemia cases. Fewer than five subjects were in the remaining CA categories precluding analysis. CONCLUSIONS Overall, we did not find evidence to support an association between CAs and infant leukemia.
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Affiliation(s)
- Kimberly J. Johnson
- Department of Pediatrics, Division of Epidemiology/Clinical Research, University of Minnesota, Minneapolis, MN
| | - Michelle A. Roesler
- Department of Pediatrics, Division of Epidemiology/Clinical Research, University of Minnesota, Minneapolis, MN
| | - Amy M. Linabery
- Department of Pediatrics, Division of Epidemiology/Clinical Research, University of Minnesota, Minneapolis, MN
| | - Joanne M. Hilden
- Department of Pediatric Hematology/Oncology, Peyton Manning Children’s Hospital at St. Vincent, Indianapolis, IN
| | | | - Julie A. Ross
- Department of Pediatrics, Division of Epidemiology/Clinical Research, University of Minnesota, Minneapolis, MN
,Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455
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23
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Busby CC. Very low dose fetal exposure to Chernobyl contamination resulted in increases in infant leukemia in Europe and raises questions about current radiation risk models. Int J Environ Res Public Health 2009; 6:3105-14. [PMID: 20049249 DOI: 10.3390/ijerph6123105] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 11/25/2009] [Indexed: 12/02/2022]
Abstract
Following contamination from the Chernobyl accident in April 1986 excess infant leukemia (0–1 y) was reported from five different countries, Scotland, Greece, Germany, Belarus and Wales and Scotland combined. The cumulative absorbed doses to the fetus, as conventionally assessed, varied from 0.02 mSv in the UK through 0.06 mSv in Germany, 0.2 mSv in Greece and 2 mSv in Belarus, where it was highest. Nevertheless, the effect was real and given the specificity of the cohort raised questions about the safety of applying the current radiation risk model of the International Commission on Radiological Protection (ICRP) to these internal exposures, a matter which was discussed in 2000 by Busby and Cato [7,8] and also in the reports of the UK Committee examining Radiation Risk from Internal Emitters. Data on infant leukemia in the United Kingdom, chosen on the basis of the cohorts defined by the study of Greece were supplied by the UK Childhood Cancer Research Group. This has enabled a study of leukemia in the combined infant population of 15,466,845 born in the UK, Greece, and Germany between 1980 and 1990. Results show a statistically significant excess risk RR = 1.43 (95% CI 1.13 < RR < 1.80 (2-tailed); p = 0.0025) in those born during the defined peak exposure period of 01/07/86 to 31/12/87 compared with those born between 01/01/80 and 31/12/85 and 01/01/88 and 31/12/90. The excess risks in individual countries do not increase monotonically with the conventionally calculated doses, the relation being biphasic, increasing sharply at low doses and falling at high doses. This result is discussed in relation to fetal/cell death at higher doses and also to induction of DNA repair. Since the cohort is chosen specifically on the basis of exposure to internal radionuclides, the result can be expressed as evidence for a significant error in the conventional modeling for such internal fetal exposures.
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