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Atkin ND, Raimer HM, Wang Z, Zang C, Wang YH. Assessing acute myeloid leukemia susceptibility in rearrangement-driven patients by DNA breakage at topoisomerase II and CCCTC-binding factor/cohesin binding sites. Genes Chromosomes Cancer 2021; 60:808-821. [PMID: 34405474 PMCID: PMC8511143 DOI: 10.1002/gcc.22993] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/29/2022] Open
Abstract
An initiating DNA double strand break (DSB) event precedes the formation of cancer-driven chromosomal abnormalities, such as gene rearrangements. Therefore, measuring DNA breaks at rearrangement-participating regions can provide a unique tool to identify and characterize susceptible individuals. Here, we developed a highly sensitive and low-input DNA break mapping method, the first of its kind for patient samples. We then measured genome-wide DNA breakage in normal cells of acute myeloid leukemia (AML) patients with KMT2A (previously MLL) rearrangements, compared to that of nonfusion AML individuals, as a means to evaluate individual susceptibility to gene rearrangements. DNA breakage at the KMT2A gene region was significantly greater in fusion-driven remission individuals, as compared to nonfusion individuals. Moreover, we identified select topoisomerase II (TOP2)-sensitive and CCCTC-binding factor (CTCF)/cohesin-binding sites with preferential DNA breakage in fusion-driven patients. Importantly, measuring DSBs at these sites, in addition to the KMT2A gene region, provided greater predictive power when assessing individual break susceptibility. We also demonstrated that low-dose etoposide exposure further elevated DNA breakage at these regions in fusion-driven AML patients, but not in nonfusion patients, indicating that these sites are preferentially sensitive to TOP2 activity in fusion-driven AML patients. These results support that mapping of DSBs in patients enables discovery of novel break-prone regions and monitoring of individuals susceptible to chromosomal abnormalities, and thus cancer. This will build the foundation for early detection of cancer-susceptible individuals, as well as those preferentially susceptible to therapy-related malignancies caused by treatment with TOP2 poisons.
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MESH Headings
- Binding Sites/genetics
- CCCTC-Binding Factor/blood
- CCCTC-Binding Factor/genetics
- Cell Cycle Proteins/blood
- Cell Cycle Proteins/genetics
- Chondroitin Sulfate Proteoglycans/blood
- Chondroitin Sulfate Proteoglycans/genetics
- Chromosomal Proteins, Non-Histone/blood
- Chromosomal Proteins, Non-Histone/genetics
- Chromosome Aberrations
- DNA Breaks, Double-Stranded/drug effects
- DNA Repair/genetics
- DNA Topoisomerases, Type II/blood
- DNA Topoisomerases, Type II/genetics
- DNA-Binding Proteins/blood
- DNA-Binding Proteins/genetics
- Etoposide/pharmacology
- Female
- Gene Rearrangement/genetics
- Genome, Human/genetics
- HeLa Cells
- Histone-Lysine N-Methyltransferase/blood
- Histone-Lysine N-Methyltransferase/genetics
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Myeloid-Lymphoid Leukemia Protein/blood
- Myeloid-Lymphoid Leukemia Protein/genetics
- Oncogene Proteins, Fusion/genetics
- Poly-ADP-Ribose Binding Proteins/blood
- Poly-ADP-Ribose Binding Proteins/genetics
- Cohesins
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Affiliation(s)
- Naomi D. Atkin
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
| | - Heather M. Raimer
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
| | - Zhenjia Wang
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
| | - Chongzhi Zang
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
| | - Yuh-Hwa Wang
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, Virginia, 22908-0733, USA
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Abstract
The diagnostics of leukemia relies upon multi-parametric approach involving a number of different pathology disciplines such as flow cytometry, histopathology, cytogenetics and molecular genetics [fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR)]. Childhood leukemia is often determined by the presence of specific chromosomal translocation that entails the generation of preleukemic fusion genes (PFG). In the last two decades, several studies have reported observations that PFG are present in healthy population and not necessarily result in leukemia. The first such study by Limpens and colleagues on t(14/18)/ BCL2-JH [1] and next in line [2, 3] led to many questions regarding the significance of these chromosomal translocations in leukemogenesis. However, the data on the incidence of PFG are contradictive. This review aims to highlight the molecular genetic approaches used by various studies with regard to differences in diagnostics and incidence of PFG in healthy subjects. The focus is on the incidence and prevalence of the most common PFG such as TEL-AML1, MLL-AF4, BCR-ABL (p190), AML1-ETO, PML-RARA, and CBFB-MYH11 detected in umbilical cord blood, in neonatal blood spots (Guthrie cards (GC)), bone marrow, peripheral blood and tissues of amortized fetuses. We conclude that the incidence of PFG is significantly higher than incidence of leukemia and more sophisticated analysis of PFG in leukemogenic cell populations is warranted to relate the occurrence of PFG with leukemia. The emerging notion is that only those PFG may contribute to development of leukemia which arise in stem cells at specific time windows during development. Thus, screening of PFG in subpopulations of stem cells may be a challenge for assessment of predisposition to leukemia and for validation of cell transplant to minimize donor cell-derived leukemia.
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Spinelli O, Peruta B, Tosi M, Guerini V, Salvi A, Zanotti MC, Oldani E, Grassi A, Intermesoli T, Micò C, Rossi G, Fabris P, Lambertenghi-Deliliers G, Angelucci E, Barbui T, Bassan R, Rambaldi A. Clearance of minimal residual disease after allogeneic stem cell transplantation and the prediction of the clinical outcome of adult patients with high-risk acute lymphoblastic leukemia. Haematologica 2007; 92:612-8. [PMID: 17488684 DOI: 10.3324/haematol.10965] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The molecular analysis of minimal residual disease (MRD) may provide information on the risk of recurrence in patients with acute lymphoblastic leukemia (ALL). The aim of this study was to correlate the kinetics of MRD clearance after allogeneic transplantation with the clinical outcome of adults with ALL. DESIGN AND METHODS MRD was evaluated by real-time quantitative polymerase chain reaction (RQ-PCR) using probes derived from fusion chimeric genes (BCR/ABL and MLL/AF4) (n=22) or rearrangements of the T-cell receptor or immunoglobulin genes (n=21). Forty-three adult patients with ALL were studied to correlate the kinetics of MRD clearance before and after allogeneic hematopoietic stem cell transplantation. RESULTS At 36 months, the overall survival of patients who underwent transplantation in hematologic remission (n= 37) was 80% for those who were PCR-negative before transplantation (n= 12) compared to 49% for PCR-positive patients (n= 25)(p=0.17). For the same patients the cumulative incidence of relapse was 0% and 46%, respectively (p=0.027). Moreover, the relapse rate of patients who were PCR-negative at day +100 after transplantation was remarkably low (7%) compared to that among patients who were PCR-positive (80%, p=0.0006). INTERPRETATION AND CONCLUSIONS The kinetics of MRD clearance may help to identify patients at high risk of leukemia relapse after allogeneic stem cell transplantation. Patients not achieving an early molecular remission after transplantation require prompt and appropriate pre-emptive treatments such as infusions of donor lymphocytes or new experimental drugs.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Basic Helix-Loop-Helix Transcription Factors/genetics
- Benzamides
- Biomarkers, Tumor/blood
- Clinical Trials as Topic/statistics & numerical data
- Cohort Studies
- Combined Modality Therapy
- Female
- Fusion Proteins, bcr-abl/blood
- Gene Deletion
- Gene Rearrangement, B-Lymphocyte
- Gene Rearrangement, T-Lymphocyte
- Hematopoietic Stem Cell Transplantation
- Humans
- Imatinib Mesylate
- Kaplan-Meier Estimate
- Kinetics
- Leukemia-Lymphoma, Adult T-Cell/blood
- Leukemia-Lymphoma, Adult T-Cell/drug therapy
- Leukemia-Lymphoma, Adult T-Cell/genetics
- Leukemia-Lymphoma, Adult T-Cell/mortality
- Leukemia-Lymphoma, Adult T-Cell/pathology
- Leukemia-Lymphoma, Adult T-Cell/surgery
- Male
- Middle Aged
- Multicenter Studies as Topic
- Myeloid-Lymphoid Leukemia Protein/blood
- Neoplasm, Residual
- Oncogene Proteins, Fusion/blood
- Piperazines/administration & dosage
- Polymerase Chain Reaction
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Proto-Oncogene Proteins/genetics
- Pyrimidines/administration & dosage
- Remission Induction
- Risk
- Survival Analysis
- Survival Rate
- T-Cell Acute Lymphocytic Leukemia Protein 1
- Translocation, Genetic
- Transplantation Conditioning
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- Orietta Spinelli
- Hematology and Bone Marrow Transplantation Units of Ospedali Riuniti Bergamo, Bergamo, Italy
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Burjanivova T, Madzo J, Muzikova K, Meyer C, Schneider B, Votava F, Marschalek R, Stary J, Trka J, Zuna J. Prenatal origin of childhood AML occurs less frequently than in childhood ALL. BMC Cancer 2006; 6:100. [PMID: 16630339 PMCID: PMC1463004 DOI: 10.1186/1471-2407-6-100] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 04/21/2006] [Indexed: 11/17/2022] Open
Abstract
Background While there is enough convincing evidence in childhood acute lymphoblastic leukemia (ALL), the data on the pre-natal origin in childhood acute myeloid leukemia (AML) are less comprehensive. Our study aimed to screen Guthrie cards (neonatal blood spots) of non-infant childhood AML and ALL patients for the presence of their respective leukemic markers. Methods We analysed Guthrie cards of 12 ALL patients aged 2–6 years using immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements (n = 15) and/or intronic breakpoints of TEL/AML1 fusion gene (n = 3). In AML patients (n = 13, age 1–14 years) PML/RARalpha (n = 4), CBFbeta/MYH11 (n = 3), AML1/ETO (n = 2), MLL/AF6 (n = 1), MLL/AF9 (n = 1) and MLL/AF10 (n = 1) fusion genes and/or internal tandem duplication of FLT3 gene (FLT3/ITD) (n = 2) were used as clonotypic markers. Assay sensitivity determined using serial dilutions of patient DNA into the DNA of a healthy donor allowed us to detect the pre-leukemic clone in Guthrie card providing 1–3 positive cells were present in the neonatal blood spot. Results In 3 patients with ALL (25%) we reproducibly detected their leukemic markers (Ig/TCR n = 2; TEL/AML1 n = 1) in the Guthrie card. We did not find patient-specific molecular markers in any patient with AML. Conclusion In the largest cohort examined so far we used identical approach for the backtracking of non-infant childhood ALL and AML. Our data suggest that either the prenatal origin of AML is less frequent or the load of pre-leukemic cells is significantly lower at birth in AML compared to ALL cases.
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MESH Headings
- Biomarkers, Tumor/blood
- Bone Marrow Cells/chemistry
- Child
- Child, Preschool
- Clone Cells/chemistry
- Cohort Studies
- Core Binding Factor Alpha 2 Subunit/blood
- Core Binding Factor Alpha 2 Subunit/genetics
- DNA, Neoplasm/blood
- Female
- Fetal Blood/chemistry
- Gene Duplication
- Gene Rearrangement, B-Lymphocyte
- Gene Rearrangement, T-Lymphocyte
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/embryology
- Leukemia, Myeloid/epidemiology
- Leukemia, Myeloid/genetics
- Male
- Myeloid-Lymphoid Leukemia Protein/blood
- Myeloid-Lymphoid Leukemia Protein/genetics
- Neonatal Screening
- Neoplasm Proteins/blood
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/blood
- Oncogene Proteins, Fusion/genetics
- Polymerase Chain Reaction
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/embryology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- RUNX1 Translocation Partner 1 Protein
- Tandem Repeat Sequences
- fms-Like Tyrosine Kinase 3/blood
- fms-Like Tyrosine Kinase 3/genetics
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Affiliation(s)
- Tatiana Burjanivova
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Jozef Madzo
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Katerina Muzikova
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Claus Meyer
- Institute of Pharmaceutical Biology/DCAL, University of Frankfurt, Frankfurt/Main, Germany
| | - Bjoern Schneider
- Institute of Pharmaceutical Biology/DCAL, University of Frankfurt, Frankfurt/Main, Germany
| | - Felix Votava
- Department of Pediatrics, Charles University Prague, 3rd Medical School, Czech Republic
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology/DCAL, University of Frankfurt, Frankfurt/Main, Germany
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Jan Trka
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Jan Zuna
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
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Tobal K. Prognostic value of minimal residual disease monitoring in acute myeloid leukemia patients with t(9;11)(p22;q23). Haematologica 2005; 90:1586A. [PMID: 16330423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
MESH Headings
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 9/genetics
- Chromosomes, Human, Pair 9/ultrastructure
- Humans
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Myeloid-Lymphoid Leukemia Protein/blood
- Neoplasm, Residual
- Oncogene Proteins, Fusion/blood
- Polymerase Chain Reaction/methods
- Prognosis
- Remission Induction
- Survival Analysis
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Khalid Tobal
- Department of Hematologic Medicine, King's College Hospital, The Rayne Institute, London, UK.
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Scholl C, Schlenk RF, Eiwen K, Döhner H, Fröhling S, Döhner K. The prognostic value of MLL-AF9 detection in patients with t(9;11)(p22;q23)-positive acute myeloid leukemia. Haematologica 2005; 90:1626-34. [PMID: 16330435] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Translocation (9;11) is the most common t(11q23) in acute myeloid leukemia (AML). A considerable number of patients with this cytogenetic abnormality relapse and die of their disease. We evaluated the clinical significance of minimal residual disease (MRD) monitoring in t(9;11)(p22;q23)-positive AML patients using real-time quantitative reverse transcriptase polymerase chain reaction (RQ-PCR) analysis. DESIGN AND METHODS We identified 34 newly diagnosed patients with t(9;11)(p22;q23)-positive AML treated within three multicenter trials of the AML Study Group. MRD could be investigated by RQ-PCR in 19 patients during and after therapy. Because of the relatively low sensitivity of the RQ-PCR (10(-3) to 10(-4) at the cellular level), samples from RQ-PCR-negative patients were also analyzed by nested polymerase chain reaction (nPCR; sensitivity 10-4 to 10-5 at the cellular level). RESULTS RQ-PCR monitoring revealed two groups of patients: group 1 (n=11) had negative RQ-PCR in all samples collected in hematologic complete remission whereas group 2 (n=8) had at least one positive RQ-PCR in samples collected in complete remission during therapy. Group 1 had a significantly lower cumulative incidence of relapse (p=0.004) and better overall survival (p=0.003) compared to group 2. nPCR did not add information to that gained from RQ-PCR. Molecular relapse was detected in two patients by RQ-PCR four and six weeks, respectively before hematologic relapse occurred. Quantitative MLL-AF9 levels at diagnosis or during and after therapy had no prognostic impact. INTERPRETATION AND CONCLUSIONS Early achievement of sustained RQ-PCR negativity appears to be a prerequisite for long-term hematologic complete remission in t(9;11)-positive AML. Furthermore, RQ-PCR might be useful for early detection of relapse. Additional patients need to be studied to corroborate these findings.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 9/genetics
- Chromosomes, Human, Pair 9/ultrastructure
- Cohort Studies
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Etoposide/administration & dosage
- Humans
- Idarubicin/administration & dosage
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid/surgery
- Middle Aged
- Mitoxantrone/administration & dosage
- Multicenter Studies as Topic
- Myeloid-Lymphoid Leukemia Protein/blood
- Neoplasm, Residual
- Oncogene Proteins, Fusion/blood
- Peripheral Blood Stem Cell Transplantation
- Polymerase Chain Reaction/methods
- Prognosis
- Randomized Controlled Trials as Topic
- Recurrence
- Remission Induction
- Survival Analysis
- Translocation, Genetic
- Treatment Outcome
- Tretinoin/administration & dosage
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Affiliation(s)
- Claudia Scholl
- Department of Internal Medicine III, University Hospital of Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany
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