1
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Lin WY, Fordham SE, Hungate E, Sunter NJ, Elstob C, Xu Y, Park C, Quante A, Strauch K, Gieger C, Skol A, Rahman T, Sucheston-Campbell L, Wang J, Hahn T, Clay-Gilmour AI, Jones GL, Marr HJ, Jackson GH, Menne T, Collin M, Ivey A, Hills RK, Burnett AK, Russell NH, Fitzgibbon J, Larson RA, Le Beau MM, Stock W, Heidenreich O, Alharbi A, Allsup DJ, Houlston RS, Norden J, Dickinson AM, Douglas E, Lendrem C, Daly AK, Palm L, Piechocki K, Jeffries S, Bornhäuser M, Röllig C, Altmann H, Ruhnke L, Kunadt D, Wagenführ L, Cordell HJ, Darlay R, Andersen MK, Fontana MC, Martinelli G, Marconi G, Sanz MA, Cervera J, Gómez-Seguí I, Cluzeau T, Moreilhon C, Raynaud S, Sill H, Voso MT, Lo-Coco F, Dombret H, Cheok M, Preudhomme C, Gale RE, Linch D, Gaal-Wesinger J, Masszi A, Nowak D, Hofmann WK, Gilkes A, Porkka K, Milosevic Feenstra JD, Kralovics R, Grimwade D, Meggendorfer M, Haferlach T, Krizsán S, Bödör C, Stölzel F, Onel K, Allan JM. Author Correction: Genome-wide association study identifies susceptibility loci for acute myeloid leukemia. Nat Commun 2022; 13:2. [PMID: 34983928 PMCID: PMC8727612 DOI: 10.1038/s41467-021-27679-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Wei-Yu Lin
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah E Fordham
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Eric Hungate
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Nicola J Sunter
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Elstob
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yaobo Xu
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Park
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anne Quante
- Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Ludwig-Maximilians-Universität München, Chair of Genetic Epidemiology, IBE, Faculty of Medicine, Munich, Germany
| | - Konstantin Strauch
- Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Ludwig-Maximilians-Universität München, Chair of Genetic Epidemiology, IBE, Faculty of Medicine, Munich, Germany
| | - Christian Gieger
- Ludwig-Maximilians-Universität München, Chair of Genetic Epidemiology, IBE, Faculty of Medicine, Munich, Germany
| | - Andrew Skol
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Thahira Rahman
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Junke Wang
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Alyssa I Clay-Gilmour
- Arnold School of Public Health, Department of Epidemiology & Biostatistics, University of South Carolina, Greenville, SC, USA
| | - Gail L Jones
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Helen J Marr
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Graham H Jackson
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Mathew Collin
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College Medical School, London, UK
| | - Robert K Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alan K Burnett
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow, UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jude Fitzgibbon
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Richard A Larson
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Michelle M Le Beau
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Wendy Stock
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Olaf Heidenreich
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Abrar Alharbi
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - David J Allsup
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Jean Norden
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anne M Dickinson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Douglas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Lendrem
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ann K Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Palm
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - Kim Piechocki
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - Sally Jeffries
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - Martin Bornhäuser
- Department of Haematological Medicine, The Rayne Institute, King's College London, London, UK.,National Center for Tumor Diseases NCT, Partner site Dresden, Dresden, Germany.,Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Heidi Altmann
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Leo Ruhnke
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Desiree Kunadt
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Lisa Wagenführ
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Heather J Cordell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Darlay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mette K Andersen
- Department of Clinical Genetics, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Maria C Fontana
- Institute of Hematology "L. and A. Seràgnoli", University of Bologna, Bologna, Italy.,IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Martinelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Marconi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Miguel A Sanz
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - José Cervera
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Gómez-Seguí
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Thomas Cluzeau
- Hematology department, Cote d'Azur University, CHU of Nice, Nice, France
| | - Chimène Moreilhon
- Hematology department, Cote d'Azur University, CHU of Nice, Nice, France
| | - Sophie Raynaud
- Hematology department, Cote d'Azur University, CHU of Nice, Nice, France
| | - Heinz Sill
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Maria Teresa Voso
- Università di Roma Tor Vergata, Dipartimento di Biomedicina e Prevenzione, Rome, Italy
| | - Francesco Lo-Coco
- Università di Roma Tor Vergata, Dipartimento di Biomedicina e Prevenzione, Rome, Italy
| | - Hervé Dombret
- Hôpital Saint-Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
| | - Meyling Cheok
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000, Lille, France
| | - Claude Preudhomme
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000, Lille, France
| | - Rosemary E Gale
- Department of Haematology, University College London Cancer Institute, London, UK
| | - David Linch
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Julia Gaal-Wesinger
- 1st Department of Internal Medicine, Semmewleis University, Budapest, Hungary
| | - Andras Masszi
- 3rd Department of Internal Medicine, Semmewleis University, Budapest, Hungary
| | - Daniel Nowak
- Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amanda Gilkes
- Department of Haematology, University of Cardiff, Cardiff, UK
| | - Kimmo Porkka
- Helsinki University Hospital Comprehensive Cancer Center, Hematology Research Unit Helsinki, University of Helsinki, Helsinki, Finland
| | | | - Robert Kralovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College Medical School, London, UK
| | | | | | - Szilvia Krizsán
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Friedrich Stölzel
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany.
| | - Kenan Onel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - James M Allan
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
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2
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Lin WY, Fordham SE, Hungate E, Sunter NJ, Elstob C, Xu Y, Park C, Quante A, Strauch K, Gieger C, Skol A, Rahman T, Sucheston-Campbell L, Wang J, Hahn T, Clay-Gilmour AI, Jones GL, Marr HJ, Jackson GH, Menne T, Collin M, Ivey A, Hills RK, Burnett AK, Russell NH, Fitzgibbon J, Larson RA, Le Beau MM, Stock W, Heidenreich O, Alharbi A, Allsup DJ, Houlston RS, Norden J, Dickinson AM, Douglas E, Lendrem C, Daly AK, Palm L, Piechocki K, Jeffries S, Bornhäuser M, Röllig C, Altmann H, Ruhnke L, Kunadt D, Wagenführ L, Cordell HJ, Darlay R, Andersen MK, Fontana MC, Martinelli G, Marconi G, Sanz MA, Cervera J, Gómez-Seguí I, Cluzeau T, Moreilhon C, Raynaud S, Sill H, Voso MT, Lo-Coco F, Dombret H, Cheok M, Preudhomme C, Gale RE, Linch D, Gaal-Wesinger J, Masszi A, Nowak D, Hofmann WK, Gilkes A, Porkka K, Milosevic Feenstra JD, Kralovics R, Grimwade D, Meggendorfer M, Haferlach T, Krizsán S, Bödör C, Stölzel F, Onel K, Allan JM. Genome-wide association study identifies susceptibility loci for acute myeloid leukemia. Nat Commun 2021; 12:6233. [PMID: 34716350 PMCID: PMC8556284 DOI: 10.1038/s41467-021-26551-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/01/2021] [Indexed: 12/17/2022] Open
Abstract
Acute myeloid leukemia (AML) is a hematological malignancy with an undefined heritable risk. Here we perform a meta-analysis of three genome-wide association studies, with replication in a fourth study, incorporating a total of 4018 AML cases and 10488 controls. We identify a genome-wide significant risk locus for AML at 11q13.2 (rs4930561; P = 2.15 × 10-8; KMT5B). We also identify a genome-wide significant risk locus for the cytogenetically normal AML sub-group (N = 1287) at 6p21.32 (rs3916765; P = 1.51 × 10-10; HLA). Our results inform on AML etiology and identify putative functional genes operating in histone methylation (KMT5B) and immune function (HLA).
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Affiliation(s)
- Wei-Yu Lin
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah E Fordham
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Eric Hungate
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Nicola J Sunter
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Elstob
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yaobo Xu
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Park
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anne Quante
- Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Chair of Genetic Epidemiology, IBE, Faculty of Medicine, Munich, Germany
| | - Konstantin Strauch
- Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Chair of Genetic Epidemiology, IBE, Faculty of Medicine, Munich, Germany
| | - Christian Gieger
- Ludwig-Maximilians-Universität München, Chair of Genetic Epidemiology, IBE, Faculty of Medicine, Munich, Germany
| | - Andrew Skol
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Thahira Rahman
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Junke Wang
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Alyssa I Clay-Gilmour
- Arnold School of Public Health, Department of Epidemiology & Biostatistics, University of South Carolina, Greenville, USA
| | - Gail L Jones
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Helen J Marr
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Graham H Jackson
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Mathew Collin
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College Medical School, London, UK
| | - Robert K Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alan K Burnett
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow, UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jude Fitzgibbon
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Richard A Larson
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Michelle M Le Beau
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Wendy Stock
- Section of Pediatric Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Olaf Heidenreich
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Abrar Alharbi
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - David J Allsup
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Jean Norden
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anne M Dickinson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Douglas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Lendrem
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ann K Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Palm
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - Kim Piechocki
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - Sally Jeffries
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - Martin Bornhäuser
- Department of Haematological Medicine, The Rayne Institute, King's College London, London, UK
- National Center for Tumor Diseases NCT, Partner site Dresden, Dresden, Germany
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Heidi Altmann
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Leo Ruhnke
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Desiree Kunadt
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Lisa Wagenführ
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
| | - Heather J Cordell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Darlay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mette K Andersen
- Department of Clinical Genetics, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Maria C Fontana
- Institute of Hematology "L. and A. Seràgnoli", University of Bologna, Bologna, Italy
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Martinelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Marconi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Miguel A Sanz
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - José Cervera
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Gómez-Seguí
- Hematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Thomas Cluzeau
- Hematology department, Cote d'Azur University, CHU of Nice, Nice, France
| | - Chimène Moreilhon
- Hematology department, Cote d'Azur University, CHU of Nice, Nice, France
| | - Sophie Raynaud
- Hematology department, Cote d'Azur University, CHU of Nice, Nice, France
| | - Heinz Sill
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Maria Teresa Voso
- Università di Roma Tor Vergata, Dipartimento di Biomedicina e Prevenzione, Rome, Italy
| | - Francesco Lo-Coco
- Università di Roma Tor Vergata, Dipartimento di Biomedicina e Prevenzione, Rome, Italy
| | - Hervé Dombret
- Hôpital Saint-Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
| | - Meyling Cheok
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000, Lille, France
| | - Claude Preudhomme
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000, Lille, France
| | - Rosemary E Gale
- Department of Haematology, University College London Cancer Institute, London, UK
| | - David Linch
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Julia Gaal-Wesinger
- 1st Department of Internal Medicine, Semmewleis University, Budapest, Hungary
| | - Andras Masszi
- 3rd Department of Internal Medicine, Semmewleis University, Budapest, Hungary
| | - Daniel Nowak
- Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amanda Gilkes
- Department of Haematology, University of Cardiff, Cardiff, UK
| | - Kimmo Porkka
- Helsinki University Hospital Comprehensive Cancer Center, Hematology Research Unit Helsinki, University of Helsinki, Helsinki, Finland
| | | | - Robert Kralovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College Medical School, London, UK
| | | | | | - Szilvia Krizsán
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Friedrich Stölzel
- Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany.
| | - Kenan Onel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - James M Allan
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
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3
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Kayser S, Hills RK, Langova R, Kramer M, Guijarro F, Sustkova Z, Estey EH, Shaw CM, Ráčil Z, Mayer J, Zak P, Baer MR, Brunner AM, Szotkowski T, Cetkovsky P, Grimwade D, Walter RB, Burnett AK, Ho AD, Ehninger G, Müller-Tidow C, Platzbecker U, Thiede C, Röllig C, Schulz A, Warsow G, Brors B, Esteve J, Russell NH, Schlenk RF, Levis MJ. Characteristics and outcome of patients with acute myeloid leukaemia and t(8;16)(p11;p13): results from an International Collaborative Study. Br J Haematol 2021; 192:832-842. [PMID: 33529373 DOI: 10.1111/bjh.17336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
In acute myeloid leukaemia (AML) t(8;16)(p11;p13)/MYST3-CREBBP is a very rare abnormality. Previous small series suggested poor outcome. We report on 59 patients with t(8;16) within an international, collaborative study. Median age was 52 (range: 16-75) years. AML was de novo in 58%, therapy-related (t-AML) in 37% and secondary after myelodysplastic syndrome (s-AML) in 5%. Cytogenetics revealed a complex karyotype in 43%. Besides MYST3-CREBBP, whole-genome sequencing on a subset of 10 patients revealed recurrent mutations in ASXL1, BRD3, FLT3, MLH1, POLG, TP53, SAMD4B (n = 3, each), EYS, KRTAP9-1 SPTBN5 (n = 4, each), RUNX1 and TET2 (n = 2, each). Complete remission after intensive chemotherapy was achieved in 84%. Median follow-up was 5·48 years; five-year survival rate was 17%. Patients with s-/t-AML (P = 0·01) and those with complex karyotype (P = 0·04) had an inferior prognosis. Allogeneic haematopoietic cell transplantation (allo-HCT) was performed in 21 (36%) patients, including 15 in first complete remission (CR1). Allo-HCT in CR1 significantly improved survival (P = 0·04); multivariable analysis revealed that allo-HCT in CR1 was effective in de novo AML but not in patients with s-AML/t-AML and less in patients exhibiting a complex karyotype. In summary, outcomes of patients with t(8;16) are dismal with chemotherapy, and may be substantially improved with allo-HCT performed in CR1.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany.,NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ralitsa Langova
- Division Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Bioscience, University of Heidelberg, Heidelberg, Germany
| | - Michael Kramer
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | | | - Zuzana Sustkova
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carole M Shaw
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Zdeněk Ráčil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic.,Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Pavel Zak
- 4th Department of Internal Medicine-Hematology, Faculty of Medicine, Charles University and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Tomas Szotkowski
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Cetkovsky
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - David Grimwade
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Alan K Burnett
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - Anthony D Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Ehninger
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Angela Schulz
- Genomics and Proteomics Core Facility High Throughput Sequencing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gregor Warsow
- Omics IT and Data Management, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt Brors
- Division Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | | | - Nigel H Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
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4
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Dillon R, Ahearne MJ, Quek L, Potter N, Jovanovic J, Foot N, Valganon M, Jayne S, Dennis M, Raj K, Tauro S, Dyer MJS, Russell N, Solomon E, Grimwade D. Therapy-related leukaemias with balanced translocations can arise from pre-existing clonal haematopoiesis. Leukemia 2021; 35:2407-2411. [PMID: 33547376 PMCID: PMC8324469 DOI: 10.1038/s41375-021-01150-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Richard Dillon
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK ,grid.451052.70000 0004 0581 2008Department of Haematology, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK ,grid.239826.40000 0004 0391 895XCancer Genetics Service, Viapath, Guy’s Hospital, London, UK
| | - Matthew J. Ahearne
- grid.9918.90000 0004 1936 8411The Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK
| | - Lynn Quek
- grid.421962.a0000 0004 0641 4431Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK ,grid.13097.3c0000 0001 2322 6764Department of Haematology, King’s College, London, UK
| | - Nicola Potter
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
| | - Jelena Jovanovic
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
| | - Nicola Foot
- grid.239826.40000 0004 0391 895XCancer Genetics Service, Viapath, Guy’s Hospital, London, UK
| | - Mikel Valganon
- grid.239826.40000 0004 0391 895XCancer Genetics Service, Viapath, Guy’s Hospital, London, UK
| | - Sandrine Jayne
- grid.9918.90000 0004 1936 8411The Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK
| | - Mike Dennis
- grid.415720.50000 0004 0399 8363Department of Haematology, The Christie Hospital, Manchester, UK
| | - Kavita Raj
- grid.451052.70000 0004 0581 2008Department of Haematology, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Sudhir Tauro
- grid.416266.10000 0000 9009 9462Department of Haematology, Ninewells Hospital and Medical School, Dundee, UK
| | - Martin J. S. Dyer
- grid.9918.90000 0004 1936 8411The Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK
| | - Nigel Russell
- grid.451052.70000 0004 0581 2008Department of Haematology, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Ellen Solomon
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
| | - David Grimwade
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
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5
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Dillon R, Hills R, Freeman S, Potter N, Jovanovic J, Ivey A, Kanda AS, Runglall M, Foot N, Valganon M, Khwaja A, Cavenagh J, Smith M, Ommen HB, Overgaard UM, Dennis M, Knapper S, Kaur H, Taussig D, Mehta P, Raj K, Novitzky-Basso I, Nikolousis E, Danby R, Krishnamurthy P, Hill K, Finnegan D, Alimam S, Hurst E, Johnson P, Khan A, Salim R, Craddock C, Spearing R, Gilkes A, Gale R, Burnett A, Russell NH, Grimwade D. Molecular MRD status and outcome after transplantation in NPM1-mutated AML. Blood 2020; 135:680-688. [PMID: 31932839 PMCID: PMC7059484 DOI: 10.1182/blood.2019002959] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Recurrence
- Young Adult
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Anju Shankar Kanda
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Nicola Foot
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Mikel Valganon
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College, London, United Kingdom
| | | | | | | | | | - Mike Dennis
- Christie Hospital, Manchester, United Kingdom
| | - Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Harpreet Kaur
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Kavita Raj
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | | | | | | | | | - Kate Hill
- University Hospital, Southampton, United Kingdom
| | | | - Samah Alimam
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Erin Hurst
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | | | - Anjum Khan
- St James' Hospital, Leeds, United Kingdom
| | - Rahuman Salim
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Rosemary Gale
- Department of Haematology, University College, London, United Kingdom
| | - Alan Burnett
- Blackwaterfoot, Isle of Arran, United Kingdom; and
| | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
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6
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Kayser S, Hills RK, Luskin MR, Brunner AM, Terré C, Westermann J, Menghrajani K, Shaw C, Baer MR, Elliott MA, Perl AE, Ráčil Z, Mayer J, Zak P, Szotkowski T, de Botton S, Grimwade D, Mayer K, Walter RB, Krämer A, Burnett AK, Ho AD, Platzbecker U, Thiede C, Ehninger G, Stone RM, Röllig C, Tallman MS, Estey EH, Müller-Tidow C, Russell NH, Schlenk RF, Levis MJ. Allogeneic hematopoietic cell transplantation improves outcome of adults with t(6;9) acute myeloid leukemia: results from an international collaborative study. Haematologica 2020; 105:161-169. [PMID: 31004014 PMCID: PMC6939530 DOI: 10.3324/haematol.2018.208678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
Acute myeloid leukemia (AML) with t(6;9)(p22;q34) is a distinct entity accounting for 1-2% of AML cases. A substantial proportion of these patients have a concomitant FLT3-ITD. While outcomes are dismal with intensive chemotherapy, limited evidence suggests allogeneic hematopoietic cell transplantation (allo-HCT) may improve survival if performed early during first complete remission. We report on a cohort of 178 patients with t(6;9)(p22;q34) within an international, multicenter collaboration. Median age was 46 years (range: 16-76), AML was de novo in 88%, FLT3-ITD was present in 62%, and additional cytogenetic abnormalities in 21%. Complete remission was achieved in 81% (n=144), including 14 patients who received high-dose cytarabine after initial induction failure. With a median follow up of 5.43 years, estimated overall survival at five years was 38% (95%CI: 31-47%). Allo-HCT was performed in 117 (66%) patients, including 89 in first complete remission. Allo-HCT in first complete remission was associated with higher 5-year relapse-free and overall survival as compared to consolidation chemotherapy: 45% (95%CI: 35-59%) and 53% (95%CI: 42-66%) versus 7% (95%CI: 3-19%) and 23% (95%CI: 13-38%), respectively. For patients undergoing allo-HCT, there was no difference in overall survival rates at five years according to whether it was performed in first [53% (95%CI: 42-66%)], or second [58% (95%CI: 31-100%); n=10] complete remission or with active disease/relapse [54% (95%CI: 34-84%); n=18] (P=0.67). Neither FLT3-ITD nor additional chromosomal abnormalities impacted survival. In conclusion, outcomes of t(6;9)(p22;q34) AML are poor with chemotherapy, and can be substantially improved with allo-HCT.
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Affiliation(s)
- Sabine Kayser
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Christine Terré
- Laboratory of Hematology, André Mignot Hospital, Le Chesnay, France
| | - Jörg Westermann
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Virchow Clinic, Berlin, Germany
| | - Kamal Menghrajani
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Carole Shaw
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexander E Perl
- Division of Hematology and Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zdeněk Ráčil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Pavel Zak
- 4 Department of Internal Medicine-Hematology, Faculty of Medicine, Charles University and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Tomas Szotkowski
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | | | - David Grimwade
- Department of Medical & Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Alwin Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Anthony D Ho
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard F Schlenk
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
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7
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Marquis M, Beaubois C, Lavallée VP, Abrahamowicz M, Danieli C, Lemieux S, Ahmad I, Wei A, Ting SB, Fleming S, Schwarer A, Grimwade D, Grey W, Hills RK, Vyas P, Russell N, Sauvageau G, Hébert J. Correction: High expression of HMGA2 independently predicts poor clinical outcomes in acute myeloid leukemia. Blood Cancer J 2019; 9:28. [PMID: 30820024 PMCID: PMC6395678 DOI: 10.1038/s41408-019-0190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Since the publication of the original article the authors noticed the the affiliation details for Paresh Vyas are incorrect. The correct affiliation details for this author are given below.
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Affiliation(s)
- Miriam Marquis
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
| | - Cyrielle Beaubois
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
| | - Vincent-Philippe Lavallée
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
| | - Michal Abrahamowicz
- Epidemiology and Biostatistics Department, McGill University, Montréal, Canada
| | - Coraline Danieli
- Epidemiology and Biostatistics Department, McGill University, Montréal, Canada
| | - Sébastien Lemieux
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
- Department of Computer Science and Operations Research, Université de Montréal, Montréal, Canada
| | - Imran Ahmad
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Andrew Wei
- Department of Haematology, Alfred Hospital, Melbourne, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Stephen B Ting
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Haematology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - Shaun Fleming
- Department of Haematology, Alfred Hospital, Melbourne, Australia
| | - Anthony Schwarer
- Department of Haematology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - David Grimwade
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College London, London, UK
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
| | - William Grey
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Robert K Hills
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
- Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK
| | - Paresh Vyas
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nigel Russell
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
- Centre for Clinical Haematology, Nottingham University Hospital (City Hospital Campus), Nottingham, UK
| | - Guy Sauvageau
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Josée Hébert
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada.
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada.
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada.
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada.
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8
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Russell N, Burnett A, Hills R, Betteridge S, Dennis M, Jovanovic J, Dillon R, Grimwade D. Attenuated arsenic trioxide plus ATRA therapy for newly diagnosed and relapsed APL: long-term follow-up of the AML17 trial. Blood 2018; 132:1452-1454. [PMID: 30097508 PMCID: PMC6225356 DOI: 10.1182/blood-2018-05-851824] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nigel Russell
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alan Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Robert Hills
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie Betteridge
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Mike Dennis
- Haematology and Transplant Unit, The Christie, Manchester, United Kingdom; and
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College Medical School, London, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College Medical School, London, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College Medical School, London, United Kingdom
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9
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Testi AM, Pession A, Diverio D, Grimwade D, Gibson B, de Azevedo AC, Moran L, Leverger G, Elitzur S, Hasle H, van der Werff ten Bosch J, Smith O, De Rosa M, Piciocchi A, Lo Coco F, Foà R, Locatelli F, Kaspers GJL. Risk-adapted treatment of acute promyelocytic leukemia: results from the International Consortium for Childhood APL. Blood 2018; 132:405-412. [PMID: 29789356 DOI: 10.1182/blood-2018-03-836528] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/15/2018] [Indexed: 11/20/2022] Open
Abstract
Pediatric acute promyelocytic leukemia (APL) can be cured with all-trans retinoic acid (ATRA) and anthracycline. However, most published trials have employed high cumulative doses of anthracyclines. Here, we report the outcome of newly diagnosed APL patients enrolled in the International Consortium for Childhood APL (ICC-APL-01) trial, which reduced anthracycline exposure but extended that of ATRA. The study recruited 258 children/adolescents with molecularly/cytogenetically proven APL. Patients were stratified into standard-risk (SR) and high-risk (HR) groups according to baseline white blood cell counts (<10 × 109/L or ≥10 × 109/L); both groups received identical induction treatment with ATRA and 3 doses of idarubicin. Two or 3 blocks of consolidation therapy were administered to SR and HR patients, respectively, while maintenance therapy with low-dose chemotherapy and ATRA cycles was given to all patients for 2 years. The cumulative dose of daunorubicin equivalent anthracyclines in SR and HR patients was lower than that of previous studies (355 mg/m2 and 405 mg/m2, respectively). Hematologic remission was obtained in 97% of patients; 8 children died of intracranial hemorrhage in the first 2 weeks following diagnosis. Five-year overall and event-free survival for the whole cohort were 94.6% and 79.9%, respectively; they were 98.4% and 89.4% in SR patients and 84.3% and 74.2% in HR patients (P = .002 and P = .043, respectively). These data demonstrate that extended use of ATRA coupled to a risk-adapted consolidation can achieve high cure rates in childhood APL and limit anthracycline exposure. The trial was registered at www.clinicaltrials.gov as EudractCT 2008-002311-40.
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Affiliation(s)
- Anna Maria Testi
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Andrea Pession
- Department of Pediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Daniela Diverio
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - David Grimwade
- Division of Genetics and Molecular Medicine, King's College, London, United Kingdom
| | - Brenda Gibson
- Department of Paediatric Haematology, Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Lorena Moran
- Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina
| | - Guy Leverger
- Assistance Publique-Hôpitaux de Paris, Hospital Armand Trousseau, Sorbonne Universitè, Paris, France
| | - Sarah Elitzur
- Pediatric Hematology-Oncology, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Owen Smith
- Department of Paediatric Hematology/Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | | | - Alfonso Piciocchi
- Gruppo Italiano Malattie Ematologiche dell'Adulto Foundation, Rome, Italy
| | - Francesco Lo Coco
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gertjan J L Kaspers
- Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands; and
- Dutch Childhood Oncology Group, The Hague, The Netherlands
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10
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Marquis M, Beaubois C, Lavallée VP, Abrahamowicz M, Danieli C, Lemieux S, Ahmad I, Wei A, Ting SB, Fleming S, Schwarer A, Grimwade D, Grey W, Hills RK, Vyas P, Russell N, Sauvageau G, Hébert J. High expression of HMGA2 independently predicts poor clinical outcomes in acute myeloid leukemia. Blood Cancer J 2018; 8:68. [PMID: 30061630 PMCID: PMC6066481 DOI: 10.1038/s41408-018-0103-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022] Open
Abstract
In acute myeloid leukemia (AML), risk stratification based on cytogenetics and mutation profiling is essential but remains insufficient to select the optimal therapy. Accurate biomarkers are needed to improve prognostic assessment. We analyzed RNA sequencing and survival data of 430 AML patients and identified HMGA2 as a novel prognostic marker. We validated a quantitative PCR test to study the association of HMGA2 expression with clinical outcomes in 358 AML samples. In this training cohort, HMGA2 was highly expressed in 22.3% of AML, mostly in patients with intermediate or adverse cytogenetics. High expression levels of HMGA2 (H + ) were associated with a lower frequency of complete remission (58.8% vs 83.4%, P < 0.001), worse 3-year overall survival (OS, 13.2% vs 43.5%, P < 0.001) and relapse-free survival (RFS, 10.8% vs 44.2%, P < 0.001). A positive HMGA2 test also identified a subgroup of patients unresponsive to standard treatments. Multivariable analyses showed that H + was independently associated with significantly worse OS and RFS, including in the intermediate cytogenetic risk category. These associations were confirmed in a validation cohort of 260 patient samples from the UK NCRI AML17 trial. The HMGA2 test could be implemented in clinical trials developing novel therapeutic strategies for high-risk AML.
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Affiliation(s)
- Miriam Marquis
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
| | - Cyrielle Beaubois
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
| | - Vincent-Philippe Lavallée
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
| | - Michal Abrahamowicz
- Epidemiology and Biostatistics Department, McGill University, Montréal, Canada
| | - Coraline Danieli
- Epidemiology and Biostatistics Department, McGill University, Montréal, Canada
| | - Sébastien Lemieux
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
- Department of Computer Science and Operations Research, Université de Montréal, Montréal, Canada
| | - Imran Ahmad
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Andrew Wei
- Department of Haematology, Alfred Hospital, Melbourne, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Stephen B Ting
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Haematology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - Shaun Fleming
- Department of Haematology, Alfred Hospital, Melbourne, Australia
| | - Anthony Schwarer
- Department of Haematology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - David Grimwade
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College London, London, UK
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
| | - William Grey
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Robert K Hills
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
- Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK
| | - Paresh Vyas
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nigel Russell
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
- Centre for Clinical Haematology, Nottingham University Hospital (City Hospital Campus), Nottingham, UK
| | - Guy Sauvageau
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Josée Hébert
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada.
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada.
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada.
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada.
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11
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Marquis M, Beaubois C, Lavallée VP, Abrahamowicz M, Danieli C, Lemieux S, Ahmad I, Wei A, Ting SB, Fleming S, Schwarer A, Grimwade D, Grey W, Hills RK, Vyas P, Russell N, Sauvageau G, Hébert J. High expression of HMGA2 independently predicts poor clinical outcomes in acute myeloid leukemia. Blood Cancer J 2018. [PMID: 30061630 DOI: 10.1038/s41408‐018‐0103‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In acute myeloid leukemia (AML), risk stratification based on cytogenetics and mutation profiling is essential but remains insufficient to select the optimal therapy. Accurate biomarkers are needed to improve prognostic assessment. We analyzed RNA sequencing and survival data of 430 AML patients and identified HMGA2 as a novel prognostic marker. We validated a quantitative PCR test to study the association of HMGA2 expression with clinical outcomes in 358 AML samples. In this training cohort, HMGA2 was highly expressed in 22.3% of AML, mostly in patients with intermediate or adverse cytogenetics. High expression levels of HMGA2 (H + ) were associated with a lower frequency of complete remission (58.8% vs 83.4%, P < 0.001), worse 3-year overall survival (OS, 13.2% vs 43.5%, P < 0.001) and relapse-free survival (RFS, 10.8% vs 44.2%, P < 0.001). A positive HMGA2 test also identified a subgroup of patients unresponsive to standard treatments. Multivariable analyses showed that H + was independently associated with significantly worse OS and RFS, including in the intermediate cytogenetic risk category. These associations were confirmed in a validation cohort of 260 patient samples from the UK NCRI AML17 trial. The HMGA2 test could be implemented in clinical trials developing novel therapeutic strategies for high-risk AML.
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Affiliation(s)
- Miriam Marquis
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada.,The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
| | - Cyrielle Beaubois
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada.,The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada
| | - Vincent-Philippe Lavallée
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada.,Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada
| | - Michal Abrahamowicz
- Epidemiology and Biostatistics Department, McGill University, Montréal, Canada
| | - Coraline Danieli
- Epidemiology and Biostatistics Department, McGill University, Montréal, Canada
| | - Sébastien Lemieux
- The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada.,Department of Computer Science and Operations Research, Université de Montréal, Montréal, Canada
| | - Imran Ahmad
- Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Andrew Wei
- Department of Haematology, Alfred Hospital, Melbourne, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Stephen B Ting
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Haematology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - Shaun Fleming
- Department of Haematology, Alfred Hospital, Melbourne, Australia
| | - Anthony Schwarer
- Department of Haematology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - David Grimwade
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College London, London, UK.,UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK
| | - William Grey
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Robert K Hills
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK.,Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK
| | - Paresh Vyas
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nigel Russell
- UK National Cancer Research Institute (NCRI) Haematological Oncology Clinical Studies Group, Cardiff, UK.,Centre for Clinical Haematology, Nottingham University Hospital (City Hospital Campus), Nottingham, UK
| | - Guy Sauvageau
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada.,The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada.,Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Josée Hébert
- The Quebec Leukemia Cell Bank, Research Centre, Maisonneuve-Rosemont Hospital, Montréal, Canada. .,The Leucegene project at Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada. .,Division of Hematology-Oncology, Maisonneuve-Rosemont Hospital, Montréal, Canada. .,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada.
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12
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Freeman SD, Hills RK, Virgo P, Khan N, Couzens S, Dillon R, Gilkes A, Upton L, Nielsen OJ, Cavenagh JD, Jones G, Khwaja A, Cahalin P, Thomas I, Grimwade D, Burnett AK, Russell NH. Measurable Residual Disease at Induction Redefines Partial Response in Acute Myeloid Leukemia and Stratifies Outcomes in Patients at Standard Risk Without NPM1 Mutations. J Clin Oncol 2018; 36:1486-1497. [PMID: 29601212 PMCID: PMC5959196 DOI: 10.1200/jco.2017.76.3425] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose We investigated the effect on outcome of measurable or minimal residual disease (MRD) status after each induction course to evaluate the extent of its predictive value for acute myeloid leukemia (AML) risk groups, including NPM1 wild-type (wt) standard risk, when incorporated with other induction response criteria. Methods As part of the NCRI AML17 trial, 2,450 younger adult patients with AML or high-risk myelodysplastic syndrome had prospective multiparameter flow cytometric MRD (MFC-MRD) assessment. After course 1 (C1), responses were categorized as resistant disease (RD), partial remission (PR), and complete remission (CR) or complete remission with absolute neutrophil count < 1,000/µL or thrombocytopenia < 100,000/μL (CRi) by clinicians, with CR/CRi subdivided by MFC-MRD assay into MRD+ and MRD-. Patients without high-risk factors, including Flt3 internal tandem duplication wt/- NPM1-wt subgroup, received a second daunorubicin/cytosine arabinoside induction; course 2 (C2) was intensified for patients with high-risk factors. Results Survival outcomes from PR and MRD+ responses after C1 were similar, particularly for good- to standard-risk subgroups (5-year overall survival [OS], 27% RD v 46% PR v 51% MRD+ v 70% MRD-; P < .001). Adjusted analyses confirmed significant OS differences between C1 RD versus PR/MRD+ but not PR versus MRD+. CRi after C1 reduced OS in MRD+ (19% CRi v 45% CR; P = .001) patients, with a smaller effect after C2. The prognostic effect of C2 MFC-MRD status (relapse: hazard ratio [HR], 1.88 [95% CI, 1.50 to 2.36], P < .001; survival: HR, 1.77 [95% CI, 1.41 to 2.22], P < .001) remained significant when adjusting for C1 response. MRD positivity appeared less discriminatory in poor-risk patients by stratified analyses. For the NPM1-wt standard-risk subgroup, C2 MRD+ was significantly associated with poorer outcomes (OS, 33% v 63% MRD-, P = .003; relapse incidence, 89% when MRD+ ≥ 0.1%); transplant benefit was more apparent in patients with MRD+ (HR, 0.72; 95% CI, 0.31 to 1.69) than those with MRD- (HR, 1.68 [95% CI, 0.75 to 3.85]; P = .16 for interaction). Conclusion MFC-MRD can improve outcome stratification by extending the definition of partial response after first induction and may help predict NPM1-wt standard-risk patients with poor outcome who benefit from transplant in the first CR.
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Affiliation(s)
- Sylvie D. Freeman
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Robert K. Hills
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Paul Virgo
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Naeem Khan
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Steve Couzens
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Richard Dillon
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Gilkes
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Laura Upton
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Ove Juul Nielsen
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - James D. Cavenagh
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Gail Jones
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Asim Khwaja
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Paul Cahalin
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Ian Thomas
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - David Grimwade
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Alan K. Burnett
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Nigel H. Russell
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
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13
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Schuurhuis GJ, Heuser M, Freeman S, Béné MC, Buccisano F, Cloos J, Grimwade D, Haferlach T, Hills RK, Hourigan CS, Jorgensen JL, Kern W, Lacombe F, Maurillo L, Preudhomme C, van der Reijden BA, Thiede C, Venditti A, Vyas P, Wood BL, Walter RB, Döhner K, Roboz GJ, Ossenkoppele GJ. Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party. Blood 2018; 131:1275-1291. [PMID: 29330221 PMCID: PMC5865231 DOI: 10.1182/blood-2017-09-801498] [Citation(s) in RCA: 738] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
Measurable residual disease (MRD; previously termed minimal residual disease) is an independent, postdiagnosis, prognostic indicator in acute myeloid leukemia (AML) that is important for risk stratification and treatment planning, in conjunction with other well-established clinical, cytogenetic, and molecular data assessed at diagnosis. MRD can be evaluated using a variety of multiparameter flow cytometry and molecular protocols, but, to date, these approaches have not been qualitatively or quantitatively standardized, making their use in clinical practice challenging. The objective of this work was to identify key clinical and scientific issues in the measurement and application of MRD in AML, to achieve consensus on these issues, and to provide guidelines for the current and future use of MRD in clinical practice. The work was accomplished over 2 years, during 4 meetings by a specially designated MRD Working Party of the European LeukemiaNet. The group included 24 faculty with expertise in AML hematopathology, molecular diagnostics, clinical trials, and clinical medicine, from 19 institutions in Europe and the United States.
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Affiliation(s)
- Gerrit J Schuurhuis
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Sylvie Freeman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Francesco Buccisano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Jacqueline Cloos
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - David Grimwade
- Division of Genetics & Molecular Medicine, King's College, London, United Kingdom
| | | | - Robert K Hills
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - Jeffrey L Jorgensen
- Division of Pathology/Laboratory Medicine, Department of Hematopathology, MD Anderson Cancer Center, Houston, TX
| | | | - Francis Lacombe
- Flow Cytometry Platform, University Hospital, Bordeaux, France
| | - Luca Maurillo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claude Preudhomme
- Center of Pathology, Laboratory of Hematology, University Hospital of Lille, Lille, France
| | - Bert A van der Reijden
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christian Thiede
- Universitätsklinikum Carl Gustav Garus an der Technischen Universität Dresden, Dresden, Germany
| | - Adriano Venditti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paresh Vyas
- Medical Research Council Molecular Haematology Unit, Oxford Centre for Haematology, University of Oxford and Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom
| | - Brent L Wood
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Laboratory Medicine and
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; and
| | - Gail J Roboz
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Gert J Ossenkoppele
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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14
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Voisset E, Moravcsik E, Stratford EW, Jaye A, Palgrave CJ, Hills RK, Salomoni P, Kogan SC, Solomon E, Grimwade D. Pml nuclear body disruption cooperates in APL pathogenesis and impairs DNA damage repair pathways in mice. Blood 2018; 131:636-648. [PMID: 29191918 PMCID: PMC5805489 DOI: 10.1182/blood-2017-07-794784] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/26/2017] [Indexed: 01/20/2023] Open
Abstract
A hallmark of acute promyelocytic leukemia (APL) is altered nuclear architecture, with disruption of promyelocytic leukemia (PML) nuclear bodies (NBs) mediated by the PML-retinoic acid receptor α (RARα) oncoprotein. To address whether this phenomenon plays a role in disease pathogenesis, we generated a knock-in mouse model with NB disruption mediated by 2 point mutations (C62A/C65A) in the Pml RING domain. Although no leukemias developed in PmlC62A/C65A mice, these transgenic mice also expressing RARα linked to a dimerization domain (p50-RARα model) exhibited a doubling in the rate of leukemia, with a reduced latency period. Additionally, we found that response to targeted therapy with all-trans retinoic acid in vivo was dependent on NB integrity. PML-RARα is recognized to be insufficient for development of APL, requiring acquisition of cooperating mutations. We therefore investigated whether NB disruption might be mutagenic. Compared with wild-type cells, primary PmlC62A/C65A cells exhibited increased sister-chromatid exchange and chromosome abnormalities. Moreover, functional assays showed impaired homologous recombination (HR) and nonhomologous end-joining (NHEJ) repair pathways, with defective localization of Brca1 and Rad51 to sites of DNA damage. These data directly demonstrate that Pml NBs are critical for DNA damage responses, and suggest that Pml NB disruption is a central contributor to APL pathogenesis.
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MESH Headings
- Animals
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- DNA Damage/genetics
- DNA End-Joining Repair/genetics
- DNA Repair/genetics
- Intranuclear Inclusion Bodies/genetics
- Intranuclear Inclusion Bodies/metabolism
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Leukemia, Promyelocytic, Acute/pathology
- Mice
- Mice, Transgenic
- Mutagenesis/genetics
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Promyelocytic Leukemia Protein/genetics
- Promyelocytic Leukemia Protein/physiology
- Signal Transduction/genetics
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Affiliation(s)
- Edwige Voisset
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Eva Moravcsik
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Eva W Stratford
- Department of Tumor Biology, The Norwegian Radium Hospital/Oslo University Hospital, Oslo, Norway
| | - Amie Jaye
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | - Robert K Hills
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, United Kingdom
| | | | - Scott C Kogan
- Helen Diller Family Comprehensive Cancer Center and
- Department of Laboratory Medicine, University of California, San Francisco, CA
| | - Ellen Solomon
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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15
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Grey W, Ivey A, Milne TA, Haferlach T, Grimwade D, Uhlmann F, Voisset E, Yu V. The Cks1/Cks2 axis fine-tunes Mll1 expression and is crucial for MLL-rearranged leukaemia cell viability. Biochim Biophys Acta Mol Cell Res 2018; 1865:105-116. [PMID: 28939057 PMCID: PMC5701546 DOI: 10.1016/j.bbamcr.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/09/2017] [Accepted: 09/17/2017] [Indexed: 12/25/2022]
Abstract
The Cdc28 protein kinase subunits, Cks1 and Cks2, play dual roles in Cdk-substrate specificity and Cdk-independent protein degradation, in concert with the E3 ubiquitin ligase complexes SCFSkp2 and APCCdc20. Notable targets controlled by Cks include p27 and Cyclin A. Here, we demonstrate that Cks1 and Cks2 proteins interact with both the MllN and MllC subunits of Mll1 (Mixed-lineage leukaemia 1), and together, the Cks proteins define Mll1 levels throughout the cell cycle. Overexpression of CKS1B and CKS2 is observed in multiple human cancers, including various MLL-rearranged (MLLr) AML subtypes. To explore the importance of MLL-Fusion Protein regulation by CKS1/2, we used small molecule inhibitors (MLN4924 and C1) to modulate their protein degradation functions. These inhibitors specifically reduced the proliferation of MLLr cell lines compared to primary controls. Altogether, this study uncovers a novel regulatory pathway for MLL1, which may open a new therapeutic approach to MLLr leukaemia.
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Affiliation(s)
- William Grey
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK.
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Thomas A Milne
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, NIHR Oxford Biomedical Research Centre Programme, University of Oxford, UK
| | | | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Frank Uhlmann
- Chromosome Segregation Laboratory, The Francis Crick Institute, London, UK
| | - Edwige Voisset
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK.
| | - Veronica Yu
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
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16
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Kayser S, Krzykalla J, Elliott MA, Norsworthy K, Gonzales P, Hills RK, Baer MR, Ráčil Z, Mayer J, Novak J, Žák P, Szotkowski T, Grimwade D, Russell NH, Walter RB, Estey EH, Westermann J, Görner M, Benner A, Krämer A, Smith BD, Burnett AK, Thiede C, Röllig C, Ho AD, Ehninger G, Schlenk RF, Tallman MS, Levis MJ, Platzbecker U. Characteristics and outcome of patients with therapy-related acute promyelocytic leukemia front-line treated with or without arsenic trioxide. Leukemia 2017; 31:2347-2354. [PMID: 28322237 PMCID: PMC6037311 DOI: 10.1038/leu.2017.92] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 02/08/2023]
Abstract
Therapy-related acute promyelocytic leukemia (t-APL) is relatively rare, with limited data on outcome after treatment with arsenic trioxide (ATO) compared to standard intensive chemotherapy (CTX). We evaluated 103 adult t-APL patients undergoing treatment with all-trans retinoic acid (ATRA) alone (n=7) or in combination with ATO (n=24), CTX (n=53), or both (n=19). Complete remissions were achieved after induction therapy in 57% with ATRA, 100% with ATO/ATRA, 78% with CTX/ATRA, and 95% with CTX/ATO/ATRA. Early death rates were 43% for ATRA, 0% for ATO/ATRA, 12% for CTX/ATRA and 5% for CTX/ATO/ATRA. Three patients relapsed, two developed therapy-related acute myeloid leukemia and 13 died in remission including seven patients with recurrence of the prior malignancy. Median follow-up for survival was 3.7 years. None of the patients treated with ATRA alone survived beyond one year. Event-free survival was significantly higher after ATO-based therapy (95%, 95% CI, 82-99%) as compared to CTX/ATRA (78%, 95% CI, 64-87%; P=0.042), if deaths due to recurrence of the prior malignancy were censored. The estimated 2-year overall survival in intensively treated patients was 88% (95% CI, 80-93%) without difference according to treatment (P=0.47). ATO when added to ATRA or CTX/ATRA is feasible and leads to better outcomes as compared to CTX/ATRA in t-APL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arsenic Trioxide
- Arsenicals/therapeutic use
- Female
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/etiology
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Oxides/therapeutic use
- Remission Induction
- Survival Analysis
- Treatment Outcome
- Young Adult
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Affiliation(s)
- S Kayser
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Internal Medicine V, Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - J Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - MA Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - K Norsworthy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - P Gonzales
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - RK Hills
- Cardiff University School of Medicine, Cardiff, UK
| | - MR Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Z Ráčil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - J Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - J Novak
- 3rd Faculty of Medicine, Department of Internal Medicine and Haematology, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - P Žák
- Faculty of Medicine, 4th Department of Internal Medicine-Hematology, Charles University and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - T Szotkowski
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - D Grimwade
- Faculty of Life Sciences and Medicine, Department of Medical & Molecular Genetics, King’s College London, London, UK
| | - NH Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - RB Walter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - EH Estey
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - J Westermann
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Virchow Clinic, Berlin, Germany
| | - M Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - A Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - A Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Internal Medicine V, Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - BD Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - AK Burnett
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Thiede
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - C Röllig
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - AD Ho
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - G Ehninger
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - RF Schlenk
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - MS Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - MJ Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - U Platzbecker
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
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17
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Iaccarino L, Ottone T, Hasan SK, Divona M, Cicconi L, Lavorgna S, Alfonso V, Basso G, Barragán E, Bocchia M, Rego EM, Grimwade D, Voso MT, Lo-Coco F. Comparative genomic analysis of PML and RARA breakpoints in paired diagnosis/relapse samples of patients with acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Leuk Lymphoma 2017; 59:1268-1270. [PMID: 28838264 DOI: 10.1080/10428194.2017.1369067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Licia Iaccarino
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Tiziana Ottone
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Syed Khizer Hasan
- b Department of Medical Oncology ACTREC , Tata Memorial Centre , Navi Mumbai , India
| | - Mariadomenica Divona
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Laura Cicconi
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Serena Lavorgna
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Valentina Alfonso
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Giuseppe Basso
- c Department of Women's and Children's Health , University of Padova , Padova , Italy
| | - Eva Barragán
- d Department of Clinical Chemistry, Laboratory of Molecular Biology , Hospital Universitario La Fe , Valencia , Spain
| | - Monica Bocchia
- e Department of Medicine and Immunological Sciences, Division of Hematology and Transplants , University of Siena , Siena , Italy
| | - Eduardo Magalhaes Rego
- f Department of Internal Medicine, Medical School of Ribeirao Preto and Center for Cell Based Therapy , University of São Paulo , Ribeirao Preto , Brazil
| | - David Grimwade
- g Department of Medical and Molecular Genetics , King's College London School of Medicine , London , UK
| | - Maria Teresa Voso
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
| | - Francesco Lo-Coco
- a Department of Biomedicine and Prevention , Università di Roma "Tor Vergata" , Rome , Italy
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18
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Amodeo V, A D, Betts J, Bartesaghi S, Zhang Y, Richard-Londt A, Ellis M, Roshani R, Vouri M, Galavotti S, Oberndorfer S, Leite AP, Mackay A, Lampada A, Stratford EW, Li N, Dinsdale D, Grimwade D, Jones C, Nicotera P, Michod D, Brandner S, Salomoni P. A PML/Slit Axis Controls Physiological Cell Migration and Cancer Invasion in the CNS. Cell Rep 2017; 20:411-426. [PMID: 28700942 DOI: 10.1016/j.celrep.2017.06.047] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 07/05/2016] [Revised: 05/02/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Cell migration through the brain parenchyma underpins neurogenesis and glioblastoma (GBM) development. Since GBM cells and neuroblasts use the same migratory routes, mechanisms underlying migration during neurogenesis and brain cancer pathogenesis may be similar. Here, we identify a common pathway controlling cell migration in normal and neoplastic cells in the CNS. The nuclear scaffold protein promyelocytic leukemia (PML), a regulator of forebrain development, promotes neural progenitor/stem cell (NPC) and neuroblast migration in the adult mouse brain. The PML pro-migratory role is active also in transformed mouse NPCs and in human primary GBM cells. In both normal and neoplastic settings, PML controls cell migration via Polycomb repressive complex 2 (PRC2)-mediated repression of Slits, key regulators of axon guidance. Finally, a PML/SLIT1 axis regulates sensitivity to the PML-targeting drug arsenic trioxide in primary GBM cells. Taken together, these findings uncover a drug-targetable molecular axis controlling cell migration in both normal and neoplastic cells.
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Affiliation(s)
- Valeria Amodeo
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Deli A
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Joanne Betts
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Stefano Bartesaghi
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Ying Zhang
- UCL Institute of Neurology, London, WC1N 3BG, UK
| | | | | | - Rozita Roshani
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Mikaella Vouri
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Sara Galavotti
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Sarah Oberndorfer
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Ana Paula Leite
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | - Alan Mackay
- Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Aikaterini Lampada
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK
| | | | - Ningning Li
- UCL Institute of Neurology, London, WC1N 3BG, UK
| | | | - David Grimwade
- Guy's Hospital, King's College London, London SE1 9RT, UK
| | - Chris Jones
- Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Pierluigi Nicotera
- German Centre for Neurodegenerative Diseases (DZNE), Bonn 53127, Germany
| | - David Michod
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK; UCL Institute of Child Health, London WC1N 1EH, UK
| | | | - Paolo Salomoni
- UCL Cancer Institute, London, WC1E 6DD, UK; Samantha Dickson Brain Cancer Unit, UCL Cancer Institute, London, WC1E 6DD, UK.
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19
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Khan N, Hills RK, Virgo P, Couzens S, Clark N, Gilkes A, Richardson P, Knapper S, Grimwade D, Russell NH, Burnett AK, Freeman SD. Expression of CD33 is a predictive factor for effect of gemtuzumab ozogamicin at different doses in adult acute myeloid leukaemia. Leukemia 2017; 31:1059-1068. [PMID: 27795558 PMCID: PMC5419583 DOI: 10.1038/leu.2016.309] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/05/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022]
Abstract
It remains unclear in adult acute myeloid leukaemia (AML) whether leukaemic expression of CD33, the target antigen for gemtuzumab ozogamicin (GO), adds prognostic information on GO effectiveness at different doses. CD33 expression quantified in 1583 patients recruited to UK-NCRI-AML17 (younger adults) and UK-NCRI-AML16 (older adults) trials was correlated with clinical outcomes and benefit from GO including a dose randomisation. CD33 expression associated with genetic subgroups, including lower levels in both adverse karyotype and core-binding factor (CBF)-AML, but was not independently prognostic. When comparing GO versus no GO (n=393, CBF-AMLs excluded) by stratified subgroup-adjusted analysis, patients with lowest quartile (Q1) %CD33-positivity had no benefit from GO (relapse risk, HR 2.41 (1.27-4.56), P=0.009 for trend; overall survival, HR 1.52 (0.92-2.52)). However, from the dose randomisation (NCRI-AML17, n=464, CBF-AMLs included), 6 mg/m2 GO only had a relapse benefit without increased early mortality in CD33-low (Q1) patients (relapse risk HR 0.64 (0.36-1.12) versus 1.70 (0.99-2.92) for CD33-high, P=0.007 for trend). Thus CD33 expression is a predictive factor for GO effect in adult AML; although GO does not appear to benefit the non-CBF AML patients with lowest CD33 expression a higher GO dose may be more effective for CD33-low but not CD33-high younger adults.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aminoglycosides/administration & dosage
- Aminoglycosides/pharmacology
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacology
- Biomarkers/analysis
- Dose-Response Relationship, Drug
- Female
- Gemtuzumab
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3/analysis
- Survival Rate
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Naeem Khan
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Robert K Hills
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Paul Virgo
- Department of Immunology, North Bristol NHS Trust, UK
| | - Stephen Couzens
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Nithiya Clark
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Amanda Gilkes
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Peter Richardson
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Steven Knapper
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - David Grimwade
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s & St. Thomas’ NHS Foundation Trust, London UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham
| | - Alan K Burnett
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Sylvie D Freeman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
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20
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Lange AP, Lima AS, Lucena-Araujo AR, Jácomo RH, Melo RA, Bittencourt RI, Pasquini R, Pagnano K, Fagundes EM, Chauffaille ML, Chiattone CS, Sanz MA, Lo-Coco F, Grimwade D, Rego EM. The experience of the International Consortium on Acute Promyelocytic Leukemia in monitoring minimal residual disease in acute promyelocytic leukaemia. Br J Haematol 2016; 180:915-918. [PMID: 28025822 DOI: 10.1111/bjh.14490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ana P Lange
- Haematology and Clinical Oncology Divisions, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.,Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ana S Lima
- Haematology and Clinical Oncology Divisions, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.,Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | | | - Raul A Melo
- Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE, Brazil
| | - Rosane I Bittencourt
- Haematology Service, Federal University of Rio Grande do Sul University Hospital, Porto Alegre, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Federal University of Parana University Hospital, Curitiba, Brazil
| | - Katia Pagnano
- Hemocentro, University of Campinas, Campinas, Brazil
| | - Evandro M Fagundes
- Haematology Service, Federal University of Minas Gerais University Hospital, Belo Horizonte, Brazil
| | | | | | - Miguel A Sanz
- Department of Haematology, Hospital Universitari i Politècnic La Fe and Departament de Medicina, Universitat de València, Valencia, Brazil
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University of Tor Vergata, and Santa Lucia Foundation, Rome, Italy
| | - David Grimwade
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Eduardo M Rego
- Haematology and Clinical Oncology Divisions, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.,Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
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21
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Jovanovic JV, Chillón MC, Vincent-Fabert C, Dillon R, Voisset E, Gutiérrez NC, Sanz RG, Lopez AAM, Morgan YG, Lok J, Solomon E, Duprez E, Díaz MG, Grimwade D. The cryptic IRF2BP2-RARA fusion transforms hematopoietic stem/progenitor cells and induces retinoid-sensitive acute promyelocytic leukemia. Leukemia 2016; 31:747-751. [DOI: 10.1038/leu.2016.338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Khan N, Hills RK, Knapper S, Steadman L, Qureshi U, Rector JL, Bradbury C, Russell NH, Vyas P, Burnett AK, Grimwade D, Hole PS, Freeman SD. Normal Hematopoietic Progenitor Subsets Have Distinct Reactive Oxygen Species, BCL2 and Cell-Cycle Profiles That Are Decoupled from Maturation in Acute Myeloid Leukemia. PLoS One 2016; 11:e0163291. [PMID: 27669008 PMCID: PMC5036879 DOI: 10.1371/journal.pone.0163291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/05/2016] [Indexed: 02/07/2023] Open
Abstract
In acute myeloid leukemia (AML) quiescence and low oxidative state, linked to BCL2 mitochondrial regulation, endow leukemic stem cells (LSC) with treatment-resistance. LSC in CD34+ and more mature CD34- AML have heterogeneous immunophenotypes overlapping with normal stem/progenitor cells (SPC) but may be differentiated by functional markers. We therefore investigated the oxidative/reactive oxygen species (ROS) profile, its relationship with cell-cycle/BCL2 for normal SPC, and whether altered in AML and myelodysplasia (MDS). In control BM (n = 24), ROS levels were highest in granulocyte-macrophage progenitors (GMP) and CD34- myeloid precursors but megakaryocyte-erythroid progenitors had equivalent levels to CD34+CD38low immature-SPC although they were ki67high. BCL2 upregulation was specific to GMPs. This profile was also observed for CD34+SPC in MDS-without-excess-blasts (MDS-noEB, n = 12). Erythroid CD34- precursors were, however, abnormally ROS-high in MDS-noEB, potentially linking oxidative stress to cell loss. In pre-treatment AML (n = 93) and MDS-with-excess-blasts (MDS-RAEB) (n = 14), immunophenotypic mature-SPC had similar ROS levels to co-existing immature-SPC. However ROS levels varied between AMLs; Flt3ITD+/NPM1wild-type CD34+SPC had higher ROS than NPM1mutated CD34+ or CD34- SPC. An aberrant ki67lowBCL2high immunophenotype was observed in CD34+AML (most prominent in Flt3ITD AMLs) but also in CD34- AMLs and MDS-RAEB, suggesting a shared redox/pro-survival adaptation. Some patients had BCL2 overexpression in CD34+ ROS-high as well as ROS-low fractions which may be indicative of poor early response to standard chemotherapy. Thus normal SPC subsets have distinct ROS, cell-cycle, BCL2 profiles that in AML /MDS-RAEB are decoupled from maturation. The combined profile of these functional properties in AML subpopulations may be relevant to differential treatment resistance.
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Affiliation(s)
- Naeem Khan
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Robert K. Hills
- Department of Haematology, Cardiff University School of Medicine, University Hospital Wales, Cardiff, United Kingdom
| | - Steve Knapper
- Department of Haematology, Cardiff University School of Medicine, University Hospital Wales, Cardiff, United Kingdom
| | - Lora Steadman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ushna Qureshi
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jerrald L. Rector
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Charlotte Bradbury
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Nigel H. Russell
- Centre for Clinical Haematology, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Paresh Vyas
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Alan K. Burnett
- Department of Haematology, Cardiff University School of Medicine, University Hospital Wales, Cardiff, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s & St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Paul S. Hole
- Department of Haematology, Cardiff University School of Medicine, University Hospital Wales, Cardiff, United Kingdom
| | - Sylvie D. Freeman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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23
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24
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Li S, Garrett-Bakelman FE, Chung SS, Hricik T, Rapaport F, Patel J, Dillon R, Vijay P, Brown AL, Perl AE, Connon J, Sanders MA, Valk PJ, Bullinger L, Luger S, Becker MW, Lewis ID, To LB, D’Andrea RJ, Grimwade D, Delwel R, Löwenberg B, Döhner H, Döhner K, Guzman ML, Hassane DC, Roboz GJ, Carroll M, Park CY, Neuberg DS, Levine RL, Melnick AM, Mason CE. Abstract LB-073: Epigenome evolution in relapsed acute myeloid leukemia. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Acute myeloid leukemia (AML) is a predominantly fatal hematopoietic malignancy with high inter-patient and intra-patient genetic and epigenetic heterogeneity. The prognosis of relapsed AML remains dismal, yet the epigenetic basis of relapse is still unclear. Here we investigated whether and how the epigenome evolution impacts AML progression with biological and clinical relevance.
Methods: We obtained clinical annotation and AML specimens from 138 patients with paired diagnosis and relapsed samples. We used normal bone marrow (NBM) as epigenetic/transcriptomic controls and patients’ matched germline DNA as genetic controls. We then performed DNA methylation sequencing (ERRBS), RNA-seq, and Exome-seq. For one patient with 5 serial time points, we performed whole genome sequencing (WGS), ERRBS, and single cell RNA-seq. We measured the epigenetic allele burden using a compositional entropy-based approach (Methclone) and methylation heterogeneity using epipolymorphism.
Results: We found that diagnosis stage epigenetic allele burden (ΔS < -90) was linked to an inferior clinical outcome (p = 0.0064, log-rank test of relapse-free survival). The higher significance in promoter regions implies the functional impact of epigenetic dynamics. Promoter epiallele shift was associated with more differential expression events (p = 3.8 × 10−6, Wilcoxon signed-rank test) and promoter epiallele diversity is significantly associated with single cell resolution transcriptional heterogeneity (p < 2.2 × 10−16, ANOVA test). The global methylation heterogeneity is decreased from diagnosis to relapse, indicating a selective impact of chemotherapy on epigenetic variability (p = 0.0056, paired Wilcoxon test).
We investigated epigenetic allele burden progression from diagnosis to relapse by classifying patients into three clusters using K-means clustering: those with 1) decreased, 2) stable, or 3) increased abundance of epiallele burden. No association was seen between epigenetic clusters and patterns of genetic evolution, and the genetic abundance is higher in Cluster 3 than Cluster 1 (p = 0.048, Wilcoxon test), indicating divergent paths of genetic and epigenetic evolution. We next examined differential expression in the epigenetic cluster samples at diagnosis compared to NBM. Cluster 1 specific genes were enriched for cell cycle processes, while Cluster 3 genes were enriched for immune responses (p < 0.001, gene ontology hypergeometric tests). Integrating WGS and ERRBS data showed that epiallele burden is more dynamic than somatic mutations; a significant increase in epiallele burden preceded a major increase of somatic mutational abundance.
Summary: Our results indicate that epigenetic dynamics may provide leukemia cells greater evolutionary fitness via transcriptional adaptation and is associated with clinical outcome. This provides an alternative mechanism of AML resilience during progression and a potential predictor of relapse.
Citation Format: Sheng Li, Francine E. Garrett-Bakelman, Stephen S. Chung, Todd Hricik, Franck Rapaport, Jay Patel, Richard Dillon, Priyanka Vijay, Anna L. Brown, Alexander E. Perl, Joy Connon, Mathijs A. Sanders, Peter J.M. Valk, Lars Bullinger, Selina Luger, Michael W. Becker, Ian D. Lewis, Luen Bik To, Richard J. D’Andrea, David Grimwade, Ruud Delwel, Bob Löwenberg, Hartmut Döhner, Konstanze Döhner, Monica L. Guzman, Duane C. Hassane, Gail J. Roboz, Martin Carroll, Christopher Y. Park, Donna S. Neuberg, Ross L. Levine, Ari M. Melnick, Christopher E. Mason. Epigenome evolution in relapsed acute myeloid leukemia. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-073.
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Affiliation(s)
- Sheng Li
- 1Weill Cornell Medical College, New York, NY
| | | | | | - Todd Hricik
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jay Patel
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Anna L. Brown
- 4SA Pathology, University of South Australia, and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Joy Connon
- 5University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Ian D. Lewis
- 9SA Pathology, University of South Australia, Royal Adelaide Hospital, and University of Adelaide, Adelaide, Australia
| | - Luen Bik To
- 4SA Pathology, University of South Australia, and Royal Adelaide Hospital, Adelaide, Australia
| | - Richard J. D’Andrea
- 4SA Pathology, University of South Australia, and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Ruud Delwel
- 6Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bob Löwenberg
- 6Erasmus University Medical Center, Rotterdam, Netherlands
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25
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Quek L, Otto GW, Garnett C, Lhermitte L, Karamitros D, Stoilova B, Lau IJ, Doondeea J, Usukhbayar B, Kennedy A, Metzner M, Goardon N, Ivey A, Allen C, Gale R, Davies B, Sternberg A, Killick S, Hunter H, Cahalin P, Price A, Carr A, Griffiths M, Virgo P, Mackinnon S, Grimwade D, Freeman S, Russell N, Craddock C, Mead A, Peniket A, Porcher C, Vyas P. Genetically distinct leukemic stem cells in human CD34- acute myeloid leukemia are arrested at a hemopoietic precursor-like stage. J Exp Med 2016; 213:1513-35. [PMID: 27377587 PMCID: PMC4986529 DOI: 10.1084/jem.20151775] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 05/19/2016] [Indexed: 12/16/2022] Open
Abstract
Quek and colleagues identify human leukemic stem cells (LSCs) present in CD34− AML. In-depth characterization of the functional and clonal aspects of CD34− LSCs indicates that most are similar to myeloid precursors. Our understanding of the perturbation of normal cellular differentiation hierarchies to create tumor-propagating stem cell populations is incomplete. In human acute myeloid leukemia (AML), current models suggest transformation creates leukemic stem cell (LSC) populations arrested at a progenitor-like stage expressing cell surface CD34. We show that in ∼25% of AML, with a distinct genetic mutation pattern where >98% of cells are CD34−, there are multiple, nonhierarchically arranged CD34+ and CD34− LSC populations. Within CD34− and CD34+ LSC–containing populations, LSC frequencies are similar; there are shared clonal structures and near-identical transcriptional signatures. CD34− LSCs have disordered global transcription profiles, but these profiles are enriched for transcriptional signatures of normal CD34− mature granulocyte–macrophage precursors, downstream of progenitors. But unlike mature precursors, LSCs express multiple normal stem cell transcriptional regulators previously implicated in LSC function. This suggests a new refined model of the relationship between LSCs and normal hemopoiesis in which the nature of genetic/epigenetic changes determines the disordered transcriptional program, resulting in LSC differentiation arrest at stages that are most like either progenitor or precursor stages of hemopoiesis.
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Affiliation(s)
- Lynn Quek
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK Department of Hematology, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Georg W Otto
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Catherine Garnett
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Ludovic Lhermitte
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Dimitris Karamitros
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Bilyana Stoilova
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - I-Jun Lau
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK Department of Hematology, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Jessica Doondeea
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Batchimeg Usukhbayar
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Alison Kennedy
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Marlen Metzner
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Nicolas Goardon
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Adam Ivey
- Department of Genetics, King's College London, London WC2R 2LS, England, UK
| | - Christopher Allen
- Cancer Institute, University College London, London WC1E 6BT, England, UK
| | - Rosemary Gale
- Cancer Institute, University College London, London WC1E 6BT, England, UK
| | - Benjamin Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Alexander Sternberg
- Department of Hematology, Great Western Hospital National Health Service Foundation Trust, Swindon SN3 6BB, England, UK
| | - Sally Killick
- Department of Hematology, Royal Bournemouth and Christchurch Hospital National Health Service Trust, Bournemouth BH7 7DW, England, UK
| | - Hannah Hunter
- Department of Hematology, Plymouth Hospitals National Health Service Trust, Plymouth PL6 8DH, England, UK
| | - Paul Cahalin
- Department of Hematology, Blackpool, Fylde and Wyre Hospitals National Health Service Trust, Blackpool FY3 8NR, England, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Mike Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham B15 2TG, England, UK
| | - Paul Virgo
- Department of Immunology, North Bristol National Health Service Trust, Bristol BS10 5NB, England, UK
| | - Stephen Mackinnon
- Cancer Institute, University College London, London WC1E 6BT, England, UK Department of Hematology, University College London Hospital National Health Service Foundation Trust, London NW1 2BU, England, UK
| | - David Grimwade
- Department of Genetics, King's College London, London WC2R 2LS, England, UK
| | - Sylvie Freeman
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, England, UK Department of Haematology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham B15 2TH, England, UK
| | - Nigel Russell
- Centre for Clinical Hematology, Nottingham University Hospitals National Health Service Trust, Nottingham NG5 1PB, England, UK
| | - Charles Craddock
- Department of Clinical Haematology, University of Birmingham, Birmingham B15 2TT, England, UK Department of Clinical Haematology, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham B15 2TH, England, UK
| | - Adam Mead
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK Department of Hematology, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Andrew Peniket
- Department of Hematology, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
| | - Catherine Porcher
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK
| | - Paresh Vyas
- Medical Research Council, Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX1 2JD, England, UK Department of Hematology, Oxford University Hospital National Health Service Trust, Oxford OX3 9DU, England, UK
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26
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Li S, Garrett-Bakelman FE, Chung SS, Sanders MA, Hricik T, Rapaport F, Patel J, Dillon R, Vijay P, Brown AL, Perl AE, Cannon J, Bullinger L, Luger S, Becker M, Lewis ID, To LB, Delwel R, Löwenberg B, Döhner H, Döhner K, Guzman ML, Hassane DC, Roboz GJ, Grimwade D, Valk PJM, D'Andrea RJ, Carroll M, Park CY, Neuberg D, Levine R, Melnick AM, Mason CE. Distinct evolution and dynamics of epigenetic and genetic heterogeneity in acute myeloid leukemia. Nat Med 2016; 22:792-9. [PMID: 27322744 PMCID: PMC4938719 DOI: 10.1038/nm.4125] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022]
Abstract
Genetic heterogeneity contributes to clinical outcome and progression of most tumors. Yet, little is known regarding allelic diversity for epigenetic compartments and almost no data exists for acute myeloid leukemia (AML). Here we examined epigenetic heterogeneity as assessed by cytosine methylation within defined genomic loci with four CpGs (epigenetic alleles), somatic mutations and transcriptomes of AML patient samples at serial time points. We observe that epigenetic allele burden is linked to inferior outcome and varies considerably during disease progression. Epigenetic and genetic allelic burden and patterning follow different patterns and kinetics during disease progression. We observed a subset of AMLs with high epiallele and low somatic mutation burden at diagnosis, a subset with high somatic mutation and lower epiallele burdens at diagnosis, and a subset with a mixed profile, suggesting distinct modes of tumor heterogeneity. Genes linked to promoter-associated epiallele shifts during tumor progression display increased single-cell transcriptional variance and differential expression, suggesting functional impact on gene regulation. Thus, genetic and epigenetic heterogeneity can occur with distinct kinetics, each likely able to impact biological and clinical features of tumors.
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Affiliation(s)
- Sheng Li
- Department of Physiology and Biophysics and the HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
| | - Francine E Garrett-Bakelman
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Stephen S Chung
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mathijs A Sanders
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Todd Hricik
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Franck Rapaport
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jay Patel
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Priyanka Vijay
- Tri-Institutional Training Program in Computational Biology and Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anna L Brown
- Center for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alexander E Perl
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joy Cannon
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lars Bullinger
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Selina Luger
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Becker
- University of Rochester Medical Center, Rochester, New York, USA
| | - Ian D Lewis
- Center for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Luen Bik To
- Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Ruud Delwel
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Bob Löwenberg
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Monica L Guzman
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Duane C Hassane
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Gail J Roboz
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Peter J M Valk
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Richard J D'Andrea
- Center for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Martin Carroll
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Y Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ross Levine
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ari M Melnick
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics and the HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA.,The Feil Family Brain and Mind Research Institute, New York, New York, USA
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27
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Ivey A, Hills RK, Simpson MA, Jovanovic JV, Gilkes A, Grech A, Patel Y, Bhudia N, Farah H, Mason J, Wall K, Akiki S, Griffiths M, Solomon E, McCaughan F, Linch DC, Gale RE, Vyas P, Freeman SD, Russell N, Burnett AK, Grimwade D. Assessment of Minimal Residual Disease in Standard-Risk AML. N Engl J Med 2016; 374:422-33. [PMID: 26789727 DOI: 10.1056/nejmoa1507471] [Citation(s) in RCA: 551] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the molecular heterogeneity of standard-risk acute myeloid leukemia (AML), treatment decisions are based on a limited number of molecular genetic markers and morphology-based assessment of remission. Sensitive detection of a leukemia-specific marker (e.g., a mutation in the gene encoding nucleophosmin [NPM1]) could improve prognostication by identifying submicroscopic disease during remission. METHODS We used a reverse-transcriptase quantitative polymerase-chain-reaction assay to detect minimal residual disease in 2569 samples obtained from 346 patients with NPM1-mutated AML who had undergone intensive treatment in the National Cancer Research Institute AML17 trial. We used a custom 51-gene panel to perform targeted sequencing of 223 samples obtained at the time of diagnosis and 49 samples obtained at the time of relapse. Mutations associated with preleukemic clones were tracked by means of digital polymerase chain reaction. RESULTS Molecular profiling highlighted the complexity of NPM1-mutated AML, with segregation of patients into more than 150 subgroups, thus precluding reliable outcome prediction. The determination of minimal-residual-disease status was more informative. Persistence of NPM1-mutated transcripts in blood was present in 15% of the patients after the second chemotherapy cycle and was associated with a greater risk of relapse after 3 years of follow-up than was an absence of such transcripts (82% vs. 30%; hazard ratio, 4.80; 95% confidence interval [CI], 2.95 to 7.80; P<0.001) and a lower rate of survival (24% vs. 75%; hazard ratio for death, 4.38; 95% CI, 2.57 to 7.47; P<0.001). The presence of minimal residual disease was the only independent prognostic factor for death in multivariate analysis (hazard ratio, 4.84; 95% CI, 2.57 to 9.15; P<0.001). These results were validated in an independent cohort. On sequential monitoring of minimal residual disease, relapse was reliably predicted by a rising level of NPM1-mutated transcripts. Although mutations associated with preleukemic clones remained detectable during ongoing remission after chemotherapy, NPM1 mutations were detected in 69 of 70 patients at the time of relapse and provided a better marker of disease status. CONCLUSIONS The presence of minimal residual disease, as determined by quantitation of NPM1-mutated transcripts, provided powerful prognostic information independent of other risk factors. (Funded by Bloodwise and the National Institute for Health Research; Current Controlled Trials number, ISRCTN55675535.).
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Affiliation(s)
- Adam Ivey
- From the Molecular Oncology Unit and Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, Guy's Hospital (A.I.), the Department of Medical and Molecular Genetics (M.A.S., J.V.J., E.S., D.G.) and Department of Asthma, Allergy and Respiratory Science (H.F., F.M.), Faculty of Life Sciences and Medicine, King's College London, the Department of Haematology, University College London (Y.P., D.C.L., R.E.G.), and the Innovation Department, Cancer Research UK (N.B.), London, the Experimental Cancer Medicine Centre (A. Gilkes) and Department of Haematology (R.K.H., A.K.B.), Cardiff University School of Medicine, and the Haematology Clinical Trials Unit, Cardiff University (A. Grech), Cardiff, West Midlands Regional Genetics Laboratory, Birmingham (J.M., K.W., S.A., M.G.), MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, and the National Institute for Health Research Oxford Biomedical Research Centre (P.V.), Oxford, the Department of Clinical Immunology, University of Birmingham, Birmingham (S.D.F.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.R.) - all in the United Kingdom
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28
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Grimwade D, Ivey A, Huntly BJP. Molecular landscape of acute myeloid leukemia in younger adults and its clinical relevance. Blood 2016; 127:29-41. [PMID: 26660431 PMCID: PMC4705608 DOI: 10.1182/blood-2015-07-604496] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/04/2015] [Indexed: 01/13/2023] Open
Abstract
Recent major advances in understanding the molecular basis of acute myeloid leukemia (AML) provide a double-edged sword. Although defining the topology and key features of the molecular landscape are fundamental to development of novel treatment approaches and provide opportunities for greater individualization of therapy, confirmation of the genetic complexity presents a huge challenge to successful translation into routine clinical practice. It is now clear that many genes are recurrently mutated in AML; moreover, individual leukemias harbor multiple mutations and are potentially composed of subclones with differing mutational composition, rendering each patient's AML genetically unique. In order to make sense of the overwhelming mutational data and capitalize on this clinically, it is important to identify (1) critical AML-defining molecular abnormalities that distinguish biological disease entities; (2) mutations, typically arising in subclones, that may influence prognosis but are unlikely to be ideal therapeutic targets; (3) mutations associated with preleukemic clones; and (4) mutations that have been robustly shown to confer independent prognostic information or are therapeutically relevant. The reward of identifying AML-defining molecular lesions present in all leukemic populations (including subclones) has been exemplified by acute promyelocytic leukemia, where successful targeting of the underlying PML-RARα oncoprotein has eliminated the need for chemotherapy for disease cure. Despite the molecular heterogeneity and recognizing that treatment options for other forms of AML are limited, this review will consider the scope for using novel molecular information to improve diagnosis, identify subsets of patients eligible for targeted therapies, refine outcome prediction, and track treatment response.
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Affiliation(s)
- David Grimwade
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Adam Ivey
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Brian J P Huntly
- Department of Haematology, Cambridge Institute for Medical Research and Addenbrookes Hospital, University of Cambridge, and Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, Cambridge, United Kingdom
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29
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Burnett AK, Russell NH, Hills RK, Bowen D, Kell J, Knapper S, Morgan YG, Lok J, Grech A, Jones G, Khwaja A, Friis L, McMullin MF, Hunter A, Clark RE, Grimwade D. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. Lancet Oncol 2015; 16:1295-305. [PMID: 26384238 DOI: 10.1016/s1470-2045(15)00193-x] [Citation(s) in RCA: 341] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute promyelocytic leukaemia is a chemotherapy-sensitive subgroup of acute myeloid leukaemia characterised by the presence of the PML-RARA fusion transcript. The present standard of care, chemotherapy and all-trans retinoic acid (ATRA), results in a high proportion of patients being cured. In this study, we compare a chemotherapy-free ATRA and arsenic trioxide treatment regimen with the standard chemotherapy-based regimen (ATRA and idarubicin) in both high-risk and low-risk patients with acute promyelocytic leukaemia. METHODS In the randomised, controlled, multicentre, AML17 trial, eligible patients (aged ≥16 years) with acute promyelocytic leukaemia, confirmed by the presence of the PML-RARA transcript and without significant cardiac or pulmonary comorbidities or active malignancy, and who were not pregnant or breastfeeding, were enrolled from 81 UK hospitals and randomised 1:1 to receive treatment with ATRA and arsenic trioxide or ATRA and idarubicin. ATRA was given to participants in both groups in a daily divided oral dose of 45 mg/m(2) until remission, or until day 60, and then in a 2 weeks on-2 weeks off schedule. In the ATRA and idarubicin group, idarubicin was given intravenously at 12 mg/m(2) on days 2, 4, 6, and 8 of course 1, and then at 5 mg/m(2) on days 1-4 of course 2; mitoxantrone at 10 mg/m(2) on days 1-4 of course 3, and idarubicin at 12 mg/m(2) on day 1 of the final (fourth) course. In the ATRA and arsenic trioxide group, arsenic trioxide was given intravenously at 0·3 mg/kg on days 1-5 of each course, and at 0·25 mg/kg twice weekly in weeks 2-8 of course 1 and weeks 2-4 of courses 2-5. High-risk patients (those presenting with a white blood cell count >10 × 10(9) cells per L) could receive an initial dose of the immunoconjugate gemtuzumab ozogamicin (6 mg/m(2) intravenously). Neither maintenance treatment nor CNS prophylaxis was given to patients in either group. All patients were monitored by real-time quantitative PCR. Allocation was by central computer minimisation, stratified by age, performance status, and de-novo versus secondary disease. The primary endpoint was quality of life on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health status. All analyses are by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN55675535. FINDINGS Between May 8, 2009, and Oct 3, 2013, 235 patients were enrolled and randomly assigned to ATRA and idarubicin (n=119) or ATRA and arsenic trioxide (n=116). Participants had a median age of 47 years (range 16-77; IQR 33-58) and included 57 high-risk patients. Quality of life did not differ significantly between the treatment groups (EORTC QLQ-C30 global functioning effect size 2·17 [95% CI -2·79 to 7·12; p=0·39]). Overall, 57 patients in the ATRA and idarubicin group and 40 patients in the ATRA and arsenic trioxide group reported grade 3-4 toxicities. After course 1 of treatment, grade 3-4 alopecia was reported in 23 (23%) of 98 patients in the ATRA and idarubicin group versus 5 (5%) of 95 in the ATRA and arsenic trioxide group, raised liver alanine transaminase in 11 (10%) of 108 versus 27 (25%) of 109, oral toxicity in 22 (19%) of 115 versus one (1%) of 109. After course 2 of treatment, grade 3-4 alopecia was reported in 25 (28%) of 89 patients in the ATRA and idarubicin group versus 2 (3%) of 77 in the ATRA and arsenic trioxide group; no other toxicities reached the 10% level. Patients in the ATRA and arsenic trioxide group had significantly less requirement for most aspects of supportive care than did those in the ATRA and idarubicin group. INTERPRETATION ATRA and arsenic trioxide is a feasible treatment in low-risk and high-risk patients with acute promyelocytic leukaemia, with a high cure rate and less relapse than, and survival not different to, ATRA and idarubicin, with a low incidence of liver toxicity. However, no improvement in quality of life was seen.
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Affiliation(s)
- Alan K Burnett
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK.
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Robert K Hills
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK
| | - David Bowen
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Kell
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Steve Knapper
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK
| | - Yvonne G Morgan
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Jennie Lok
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Angela Grech
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK
| | - Gail Jones
- Department of Haematology, Newcastle Teaching Hospitals NHS Trust, Newcastle, UK
| | - Asim Khwaja
- Department of Haematology, University College Hospitals, London, UK
| | - Lone Friis
- Department of Haematology, Rigshospitalet, National University Hospital, Copenhagen, Denmark
| | | | - Ann Hunter
- Department of Haematology, Leicester Royal Infirmary, Leicester, UK
| | - Richard E Clark
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
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30
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Abstract
The European LeukemiaNet (ELN) is composed of several work packages, four of them being directly involved in the various aspects of diagnosis. On the occasion of the annual ELN meeting of 2015 in Mannheim, these four work packages collectively examined the current situation and future prospects of cytomorphology, flow cytometry, cytogenetics, next-generation sequencing, and minimal residual disease detection in the context of leukemia diagnosis and follow-up. This document summarizes the outcome of this compendium.
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Affiliation(s)
- Marie C Béné
- Hematology Biology, University Hospital, Nantes, France
| | - David Grimwade
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Gina Zini
- Hematology and Clinical Pathology, Catholic University of Sacred Heart, Rome, Italy
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31
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Kühnl A, Valk PJM, Sanders MA, Ivey A, Hills RK, Mills KI, Gale RE, Kaiser MF, Dillon R, Joannides M, Gilkes A, Haferlach T, Schnittger S, Duprez E, Linch DC, Delwel R, Löwenberg B, Baldus CD, Solomon E, Burnett AK, Grimwade D. Downregulation of the Wnt inhibitor CXXC5 predicts a better prognosis in acute myeloid leukemia. Blood 2015; 125:2985-94. [PMID: 25805812 PMCID: PMC4463809 DOI: 10.1182/blood-2014-12-613703] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/11/2015] [Indexed: 12/13/2022] Open
Abstract
The gene CXXC5 on 5q31 is frequently deleted in acute myeloid leukemia (AML) with del(5q), suggesting that inactivation of CXXC5 might play a role in leukemogenesis. Here, we investigated the functional and prognostic implications of CXXC5 expression in AML. CXXC5 mRNA was downregulated in AML with MLL rearrangements, t(8;21) and GATA2 mutations. As a mechanism of CXXC5 inactivation, we found evidence for epigenetic silencing by promoter methylation. Patients with CXXC5 expression below the median level had a lower relapse rate (45% vs 59%; P = .007) and a better overall survival (OS, 46% vs 28%; P < .001) and event-free survival (EFS, 36% vs 21%; P < .001) at 5 years, independent of cytogenetic risk groups and known molecular risk factors. In gene-expression profiling, lower CXXC5 expression was associated with upregulation of cell-cycling genes and co-downregulation of genes implicated in leukemogenesis (WT1, GATA2, MLL, DNMT3B, RUNX1). Functional analyses demonstrated CXXC5 to inhibit leukemic cell proliferation and Wnt signaling and to affect the p53-dependent DNA damage response. In conclusion, our data suggest a tumor suppressor function of CXXC5 in AML. Inactivation of CXXC5 is associated with different leukemic pathways and defines an AML subgroup with better outcome.
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MESH Headings
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carrier Proteins/antagonists & inhibitors
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cell Cycle
- Cohort Studies
- DNA Methylation
- DNA-Binding Proteins
- Down-Regulation
- Female
- Follow-Up Studies
- Gene Expression Profiling
- Gene Expression Regulation, Leukemic
- Humans
- Immunoenzyme Techniques
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Mutation/genetics
- Oligonucleotide Array Sequence Analysis
- Prognosis
- Promoter Regions, Genetic/genetics
- RNA, Messenger/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction
- Survival Rate
- Transcription Factors
- Tumor Cells, Cultured
- Wnt Proteins/antagonists & inhibitors
- Young Adult
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Affiliation(s)
- Andrea Kühnl
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom; Department of Hematology and Oncology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mathijs A Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Robert K Hills
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Ken I Mills
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | - Rosemary E Gale
- Department of Haematology, University College London, London, United Kingdom
| | - Martin F Kaiser
- Department of Hematology and Oncology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Melanie Joannides
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Amanda Gilkes
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | | | - Estelle Duprez
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique UMR7258, Institut Paoli-Calmettes, Aix Marseille University, Marseille, France
| | - David C Linch
- Department of Haematology, University College London, London, United Kingdom
| | - Ruud Delwel
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claudia D Baldus
- Department of Hematology and Oncology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Ellen Solomon
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
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32
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Khan N, Freeman SD, Virgo P, Couzens S, Richardson P, Thomas I, Grech A, Vyas P, Grimwade D, Russell NH, Burnett AK, Hills RK. An immunophenotypic pre-treatment predictor for poor response to induction chemotherapy in older acute myeloid leukaemia patients: blood frequency of CD34+ CD38 low blasts. Br J Haematol 2015; 170:80-4. [PMID: 25876768 DOI: 10.1111/bjh.13398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/04/2015] [Indexed: 02/01/2023]
Abstract
Many older patients with acute myeloid leukaemia (AML) that receive standard intensive chemotherapy fail to achieve complete remission (CR). Upfront identification of patients unlikely to benefit from standard induction chemotherapy would be important for exploration of novel therapies. This study evaluated if a flow cytometric assay measuring pre-treatment CD34(+) CD38(low) blast frequency could predict therapeutic-resistance in 736 AML patients entered into the UK National Cancer Research Institute AML16 trial. High peripheral blood CD34(+) CD38(low) blast frequency (>7% of leucocytes), present in 18% of assessable patients, conferred significantly reduced CR rates (38% vs. 76%, P < 0.0001) and poor survival, and was independently prognostic for all endpoints of treatment resistance by multivariate analysis.
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Affiliation(s)
- Naeem Khan
- Department of Clinical Immunology, University of Birmingham Medical School, Birmingham, UK
| | - Sylvie D Freeman
- Department of Clinical Immunology, University of Birmingham Medical School, Birmingham, UK
| | - Paul Virgo
- Department of Immunology, North Bristol NHS Trust, Bristol, UK
| | - Steve Couzens
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Peter Richardson
- Department of Clinical Immunology, University of Birmingham Medical School, Birmingham, UK
| | - Ian Thomas
- Department of Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Angela Grech
- Department of Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Paresh Vyas
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - David Grimwade
- Department of Medical and Molecular Genetics, Kings College London School of Medicine, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Robert K Hills
- Department of Haematology, Cardiff University School of Medicine, Cardiff, UK
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33
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Grimwade D, Freeman SD. Defining minimal residual disease in acute myeloid leukemia: which platforms are ready for "prime time"? Hematology Am Soc Hematol Educ Program 2014; 2014:222-233. [PMID: 25696859 DOI: 10.1182/asheducation-2014.1.222] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The past 40 years have witnessed major advances in defining the cytogenetic aberrations, mutational landscape, epigenetic profiles, and expression changes underlying hematological malignancies. Although it has become apparent that acute myeloid leukemia (AML) is highly heterogeneous at the molecular level, the standard framework for risk stratification guiding transplant practice in this disease remains largely based on pretreatment assessment of cytogenetics and a limited panel of molecular genetic markers, coupled with morphological assessment of bone marrow (BM) blast percentage after induction. However, application of more objective methodology such as multiparameter flow cytometry (MFC) has highlighted the limitations of morphology for reliable determination of remission status. Moreover, there is a growing body of evidence that detection of subclinical levels of leukemia (ie, minimal residual disease, MRD) using MFC or molecular-based approaches provides powerful independent prognostic information. Consequently, there is increasing interest in the use of MRD detection to provide early end points in clinical trials and to inform patient management. However, implementation of MRD assessment into clinical practice remains a major challenge, hampered by differences in the assays and preferred analytical methods employed between routine laboratories. Although this should be addressed through adoption of standardized assays with external quality control, it is clear that the molecular heterogeneity of AML coupled with increasing understanding of its clonal architecture dictates that a "one size fits all" approach to MRD detection in this disease is not feasible. However, with the range of platforms now available, there is considerable scope to realistically track treatment response in every patient.
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Affiliation(s)
- David Grimwade
- Department of Medical & Molecular Genetics, King's College London School of Medicine, London, United Kingdom; and
| | - Sylvie D Freeman
- Department of Clinical Immunology, University of Birmingham Medical School, Edgbaston, Birmingham, United Kingdom
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34
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Bradbury C, Houlton AE, Akiki S, Gregg R, Rindl M, Khan J, Ward J, Khan N, Griffiths M, Nagra S, Hills R, Burnett A, Russell N, Vyas P, Grimwade D, Craddock C, Freeman SD. Prognostic value of monitoring a candidate immunophenotypic leukaemic stem/progenitor cell population in patients allografted for acute myeloid leukaemia. Leukemia 2014; 29:988-91. [PMID: 25425198 PMCID: PMC4391965 DOI: 10.1038/leu.2014.327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- C Bradbury
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - A E Houlton
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Akiki
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - R Gregg
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - M Rindl
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - J Khan
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - J Ward
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - N Khan
- Department of Clinical Immunology, University of Birmingham, Birmingham, UK
| | - M Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - S Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - R Hills
- Department of Haematology, Cardiff University, Cardiff, UK
| | - A Burnett
- Department of Haematology, Cardiff University, Cardiff, UK
| | - N Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - P Vyas
- 1] MRC Molecular Haematology Unit, WIMM, University of Oxford, Oxford, UK [2] Department of Haematology, Radcliffe Hospitals NHS Trust, Oxford, UK
| | - D Grimwade
- 1] Department of Medical & Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK [2] Department of Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - C Craddock
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S D Freeman
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Department of Clinical Immunology, University of Birmingham, Birmingham, UK
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Lucena-Araujo AR, Kim HT, Jacomo RH, Melo RA, Bittencourt R, Pasquini R, Pagnano K, Fagundes EM, Chauffaille MDL, Chiattone CS, Lima AS, Ruiz-Argüelles G, Undurraga MS, Martinez L, Kwaan HC, Gallagher R, Niemeyer CM, Schrier SL, Tallman MS, Grimwade D, Ganser A, Berliner N, Ribeiro RC, Lo-Coco F, Löwenberg B, Sanz MA, Rego EM. Internal tandem duplication of the FLT3 gene confers poor overall survival in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline-based chemotherapy: an International Consortium on Acute Promyelocytic Leukemia study. Ann Hematol 2014; 93:2001-10. [DOI: 10.1007/s00277-014-2142-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/16/2014] [Indexed: 12/20/2022]
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Lucena-Araujo AR, Kim HT, Jacomo RH, Melo RA, Bittencourt R, Pasquini R, Pagnano K, Fagundes EM, de Lourdes Chauffaille M, Chiattone CS, Lima AS, Kwaan HC, Gallagher R, Niemeyer CM, Schrier SL, Tallman MS, Grimwade D, Ganser A, Berliner N, Ribeiro RC, Lo-Coco F, Löwenberg B, Sanz MA, Rego EM. Prognostic impact of KMT2E transcript levels on outcome of patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and anthracycline-based chemotherapy: an International Consortium on Acute Promyelocytic Leukaemia study. Br J Haematol 2014; 166:540-9. [PMID: 24796963 DOI: 10.1111/bjh.12921] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/04/2014] [Indexed: 12/24/2022]
Abstract
The KMT2E (MLL5) gene encodes a histone methyltransferase implicated in the positive control of genes related to haematopoiesis. Its close relationship with retinoic acid-induced granulopoiesis suggests that the deregulated expression of KMT2E might lead acute promyelocytic leukaemia (APL) blasts to become less susceptible to the conventional treatment protocols. Here, we assessed the impact of KMT2E expression on the prognosis of 121 APL patients treated with ATRA and anthracycline-based chemotherapy. Univariate analysis showed that complete remission (P = 0·006), 2-year overall survival (OS) (P = 0·005) and 2-year disease-free survival (DFS) rates (P = 0·037) were significantly lower in patients with low KMT2E expression; additionally, the 2-year cumulative incidence of relapse was higher in patients with low KMT2E expression (P = 0·04). Multivariate analysis revealed that low KMT2E expression was independently associated with lower remission rate (odds ratio [OR]: 7·18, 95% confidence interval [CI]: 1·71-30·1; P = 0·007) and shorter OS (hazard ratio [HR]: 0·27, 95% CI: 0·08-0·87; P = 0·029). Evaluated as a continuous variable, KMT2E expression retained association with poor remission rate (OR: 10·3, 95% CI: 2·49-43·2; P = 0·001) and shorter survival (HR: 0·17, 95% IC: 0·05-0·53; P = 0·002), while the association with DFS was of marginal significance (HR: 1·01; 95% CI: 0·99-1·02; P = 0·06). In summary, low KMT2E expression may predict poor outcome in APL patients.
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Affiliation(s)
- Antonio R Lucena-Araujo
- Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; Centre for Cell Based Therapy, University of São Paulo, Ribeirão Preto, Brazil
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Abstract
Type II topoisomerases are essential enzymes that modulate DNA under- and overwinding, knotting, and tangling. Beyond their critical physiological functions, these enzymes are the targets for some of the most widely prescribed anticancer drugs (topoisomerase II poisons) in clinical use. Topoisomerase II poisons kill cells by increasing levels of covalent enzyme-cleaved DNA complexes that are normal reaction intermediates. Drugs such as etoposide, doxorubicin, and mitoxantrone are frontline therapies for a variety of solid tumors and hematological malignancies. Unfortunately, their use also is associated with the development of specific leukemias. Regimens that include etoposide or doxorubicin are linked to the occurrence of acute myeloid leukemias that feature rearrangements at chromosomal band 11q23. Similar rearrangements are seen in infant leukemias and are associated with gestational diets that are high in naturally occurring topoisomerase II-active compounds. Finally, regimens that include mitoxantrone and epirubicin are linked to acute promyelocytic leukemias that feature t(15;17) rearrangements. The first part of this article will focus on type II topoisomerases and describe the mechanism of enzyme and drug action. The second part will discuss how topoisomerase II poisons trigger chromosomal breaks that lead to leukemia and potential approaches for dissociating the actions of drugs from their leukemogenic potential.
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Affiliation(s)
- Maryjean Pendleton
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee
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38
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Dillon R, Grimwade D. Prognostic significance of additional cytogenetic abnormalities and FLT3 mutations in acute promyelocytic leukemia. Leuk Lymphoma 2014; 55:1444-6. [PMID: 24313832 DOI: 10.3109/10428194.2013.868458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College London School of Medicine , London , UK
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Uttenthal B, Martinez-Davila I, Ivey A, Craddock C, Chen F, Virchis A, Kottaridis P, Grimwade D, Khwaja A, Stauss H, Morris EC. Wilms' Tumour 1 (WT1) peptide vaccination in patients with acute myeloid leukaemia induces short-lived WT1-specific immune responses. Br J Haematol 2013; 164:366-75. [PMID: 24422723 PMCID: PMC4253125 DOI: 10.1111/bjh.12637] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 06/13/2013] [Accepted: 09/06/2013] [Indexed: 12/04/2022]
Abstract
Wilms’ Tumour 1 (WT1) is a zinc finger transcription factor that is over-expressed in acute myeloid leukaemia (AML). Its restricted expression in normal tissues makes it a promising target for novel immunotherapies aiming to accentuate the cytotoxic T lymphocyte (CTL) response against AML. Here we report a phase I/II clinical trial of subcutaneous peptide vaccination with two separate HLA-A2-binding peptide epitopes derived from WT1, together with a pan-DR binding peptide epitope (PADRE), in Montanide adjuvant. Eight HLA-A2-positive patients with poor risk AML received five vaccination cycles at 3-weekly intervals. The three cohorts received 0·3, 0·6 and 1 mg of each peptide, respectively. In six patients, WT1-specific CTL responses were detected using enzyme-linked immunosorbent spot assays and pWT126/HLA-A*0201 tetramer staining, after ex vivo stimulation with the relevant WT1 peptides. However, re-stimulation of these WT1-specific T cells failed to elicit secondary expansion in all four patients tested, suggesting that the WT1-specific CD8+ T cells generated following vaccination may be functionally impaired. No correlation was observed between peptide dose, cellular immune response, reduction in WT1mRNA expression and clinical response. Larger studies are indicated to confirm these findings.
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Affiliation(s)
- Benjamin Uttenthal
- UCL Division of Infection and Immunity, Department of Immunology, University College London, London, UK
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Freeman SD, Virgo P, Couzens S, Grimwade D, Russell N, Hills RK, Burnett AK. Prognostic relevance of treatment response measured by flow cytometric residual disease detection in older patients with acute myeloid leukemia. J Clin Oncol 2013; 31:4123-31. [PMID: 24062403 DOI: 10.1200/jco.2013.49.1753] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Older patients with acute myeloid leukemia (AML) have a high relapse rate after standard chemotherapy. We investigated whether measuring chemotherapy sensitivity by multiparameter flow cytometric minimal residual disease (MFC-MRD) detection has prognostic value in patients older than age 60 years or is simply a surrogate for known age-related risk factors. PATIENT AND METHODS Eight hundred ninety-two unselected patients treated intensively in the United Kingdom National Cancer Research Institute AML16 Trial were assessed prospectively for MFC-MRD during treatment. Eight hundred thirty-three patients had leukemia-associated immunophenotypes (LAIPs) identified by pretreatment screening. Four hundred twenty-seven patients entered complete remission (CR) after one or two courses (designated C1 and C2, respectively) and were MFC-MRD assessable by LAIP detection in CR bone marrow for at least one of these time points. MRD positivity was defined as residual disease detectable by LAIP. RESULTS MFC-MRD negativity, which was achieved in 51% of patients after C1 (n = 286) and 64% of patients after C2 (n = 279), conferred significantly better 3-year survival from CR (C1: 42% v 26% in MRD-positive patients, P < .001; C2: 38% v 18%, respectively; P < .001) and reduced relapse (C1: 71% v 83% in MRD-positive patients, P < .001; C2: 79% v 91%, respectively; P < .001), with higher risk of early relapse in MRD-positive patients (median time to relapse, 8.5 v 17.1 months, respectively). In multivariable analysis, MRD status at the post-C1 time point independently predicted survival, identifying a subgroup of intermediate-risk patients with particularly poor outcome. However, survival benefit from gemtuzumab ozogamicin was not associated with MFC-MRD chemotherapy sensitivity. CONCLUSION Early assessment of treatment response using flow cytometry provides powerful independent prognostic information in older adults with AML, lending support to the incorporation of MRD detection to refine risk stratification and inform clinical trial design in this challenging group of patients.
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Affiliation(s)
- Sylvie D Freeman
- Sylvie D. Freeman, University of Birmingham and University Hospitals Birmingham National Health Service (NHS) Trust, Birmingham; Paul Virgo, North Bristol NHS Trust, Bristol; Steve Couzens, University Hospital of Wales; Robert K. Hills and Alan K. Burnett, Cardiff University, Heath Park, Cardiff; David Grimwade, King's College London School of Medicine and Guy's and St Thomas' NHS Foundation Trust, London; and Nigel Russell, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
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Akiki S, Dyer SA, Grimwade D, Ivey A, Abou-Zeid N, Borrow J, Jeffries S, Caddick J, Newell H, Begum S, Tawana K, Mason J, Velangi M, Griffiths M. NUP98-NSD1 fusion in association with FLT3-ITD mutation identifies a prognostically relevant subgroup of pediatric acute myeloid leukemia patients suitable for monitoring by real time quantitative PCR. Genes Chromosomes Cancer 2013; 52:1053-64. [PMID: 23999921 DOI: 10.1002/gcc.22100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/10/2013] [Indexed: 12/26/2022] Open
Abstract
The cytogenetically cryptic t(5;11)(q35;p15) leading to the NUP98-NSD1 fusion is a rare but recurrent gene rearrangement recently reported to identify a group of young AML patients with poor prognosis. We used reverse transcription polymerase chain reaction (PCR) to screen retrospectively diagnostic samples from 54 unselected pediatric AML patients and designed a real time quantitative PCR assay to track individual patient response to treatment. Four positive cases (7%) were identified; three arising de novo and one therapy related AML. All had intermediate risk cytogenetic markers and a concurrent FLT3-ITD but lacked NPM1 and CEBPA mutations. The patients had a poor response to therapy and all proceeded to hematopoietic stem cell transplant. These data lend support to the adoption of screening for NUP98-NSD1 in pediatric AML without otherwise favorable genetic markers. The role of quantitative PCR is also highlighted as a potential tool for managing NUP98-NSD1 positive patients post-treatment.
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Affiliation(s)
- Susanna Akiki
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS foundation Trust, Birmingham, UK; School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Abstract
The ActiPed (FitLinxx) is a uniaxial accelerometer, which objectively measures physical activity, uploads the data wirelessly to a website, allowing participants and researchers to view activity levels remotely. The aim was to validate ActiPed's step count, distance travelled and activity time against direct observation. Further, to compare against pedometer (YAMAX), accelerometer (ActiGraph) and manufacturer's guidelines. 22 participants, aged 28±7 years, undertook 4 protocols, including walking on different surfaces and incremental running protocol (from 2 mph to 8 mph). Bland-Altman plots allowed comparison of direct observation against ActiPed estimates. For step count, the ActiPed showed a low % bias in all protocols: walking on a treadmill (-1.30%), incremental treadmill protocol (-1.98%), walking over grass (-1.67%), and walking over concrete (-0.93%). When differentiating between walking and running step count the ActiPed showed a % bias of 4.10% and -6.30%, respectively. The ActiPed showed >95% accuracy for distance and duration estimations overall, although underestimated distance (p<0.01) for walking over grass and concrete. Overall, the ActiPed showed acceptable levels of accuracy comparable to previous validated pedometers and accelerometers. The accuracy combined with the simple and informative remote gathering of data, suggests that the ActiPed could be a useful tool in objective physical activity monitoring.
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Affiliation(s)
- D K Brown
- Centre for Sports and Exercise Science, University of Essex, Colchester, UK
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44
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Craddock C, Quek L, Goardon N, Freeman S, Siddique S, Raghavan M, Aztberger A, Schuh A, Grimwade D, Ivey A, Virgo P, Hills R, McSkeane T, Arrazi J, Knapper S, Brookes C, Davies B, Price A, Wall K, Griffiths M, Cavenagh J, Majeti R, Weissman I, Burnett A, Vyas P. Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia. Leukemia 2012; 27:1028-36. [PMID: 23223186 DOI: 10.1038/leu.2012.312] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.
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Affiliation(s)
- C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
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45
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Bench AJ, White HE, Foroni L, Godfrey AL, Gerrard G, Akiki S, Awan A, Carter I, Goday-Fernandez A, Langabeer SE, Clench T, Clark J, Evans PA, Grimwade D, Schuh A, McMullin MF, Green AR, Harrison CN, Cross NCP. Molecular diagnosis of the myeloproliferative neoplasms: UK guidelines for the detection ofJAK2V617F and other relevant mutations. Br J Haematol 2012; 160:25-34. [DOI: 10.1111/bjh.12075] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony J. Bench
- Molecular Malignancy Laboratory and Haemato-Oncology Diagnostic Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge; UK
| | | | - Letizia Foroni
- Imperial Molecular Pathology; Imperial College Academic Health Science Centre; London; UK
| | - Anna L. Godfrey
- Cambridge Institute for Medical Research; Department of Haematology; University of Cambridge; Cambridge; UK
| | - Gareth Gerrard
- Imperial Molecular Pathology; Imperial College Academic Health Science Centre; London; UK
| | - Susanna Akiki
- West Midlands Regional Genetics Laboratory; Birmingham Women's NHS Foundation Trust; Birmingham; UK
| | - Abida Awan
- Molecular Diagnostics Centre; Manchester Royal Infirmary; Manchester; UK
| | - Ian Carter
- Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Andrea Goday-Fernandez
- Molecular Malignancy Laboratory and Haemato-Oncology Diagnostic Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge; UK
| | | | | | - Jordan Clark
- UK NEQAS for Leucocyte Immunophenotyping; Sheffield; UK
| | - Paul A. Evans
- HMDS, Leeds Institute of Oncology; St. James's University Hospital; Leeds; UK
| | - David Grimwade
- Department of Medical and Molecular Genetics; King's College London School of Medicine; London; UK
| | - Anna Schuh
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford; UK
| | | | - Anthony R. Green
- Cambridge Institute for Medical Research; Department of Haematology; University of Cambridge; Cambridge; UK
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Abstract
An increasing number of cytogenetic and molecular genetic aberrations have been identified in acute myeloid leukaemia (AML), highlighting the biological heterogeneity of the disease. Moreover, the characterisation of specific molecular abnormalities provides the basis for targeted therapies, such as all trans retinoic acid (ATRA) and arsenic trioxide treatment in acute promyelocytic leukaemia or tyrosine kinase inhibitors in AML with FLT3 mutations. Several cytogenetic and molecular genetic changes have been shown to be prognostically relevant and have been acknowledged in the latest WHO classification of AML as separate entities. A detailed marker assessment at diagnosis is crucial for risk-stratification of AML patients, allowing the identification of those at high risk of relapse, who may benefit from early allogeneic stem cell transplantation. Finally, molecular markers are important for the detection of minimal residual disease after initial therapy and during long-term follow-up, which enables a more tailored treatment approach for individual AML patients.
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Affiliation(s)
- Andrea Kühnl
- Department of Medical and Molecular Genetics, King's College London School of Medicine, London, UK
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47
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Grimwade D, Burnett AK. Getting to the heart of improving outcomes for patients with acute promyelocytic leukemia. Oncology (Williston Park) 2012; 26:647-649. [PMID: 22888566] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- David Grimwade
- Department of Medical and Molecular Genetics, King's College London School of Medicine, UK
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Abstract
The last 4 decades have seen major advances in understanding the genetic basis of acute myeloid leukemia (AML), and substantial improvements in survival of children and young adults with the disease. A key step forward was the discovery that AML cells harbor recurring cytogenetic abnormalities. The identification of the genes involved in chromosomal rearrangements has provided insights into the regulation of normal hematopoiesis and how disruption of key transcription factors and epigenetic modulators promote leukemic transformation. Cytogenetics has been widely adopted to provide the framework for development of risk-stratified treatment approaches to patient management.
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Affiliation(s)
- David Grimwade
- Cancer Genetics Laboratory, Department of Medical & Molecular Genetics, Guy's Hospital, King's College London School of Medicine, 8th Floor, Guy's Tower, London SE1 9RT, UK.
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Jovanovic JV, Rennie K, Culligan D, Peniket A, Lennard A, Harrison J, Vyas P, Grimwade D. Development of real-time quantitative polymerase chain reaction assays to track treatment response in retinoid resistant acute promyelocytic leukemia. Front Oncol 2011; 1:35. [PMID: 22655241 PMCID: PMC3356041 DOI: 10.3389/fonc.2011.00035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 07/31/2011] [Accepted: 09/28/2011] [Indexed: 11/23/2022] Open
Abstract
Molecular detection of minimal residual disease (MRD) has become established to assess remission status and guide therapy in patients with ProMyelocytic Leukemia-RARA+ acute promyelocytic leukemia (APL). However, there are few data on tracking disease response in patients with rarer retinoid resistant subtypes of APL, characterized by PLZF-RARA and STAT5b-RARA. Despite their rarity (<1% of APL) we identified 6 cases (PLZF-RARA, n = 5; STAT5b-RARA, n = 1), established the respective breakpoint junction regions and designed reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) assays to detect leukemic transcripts. The relative level of fusion gene expression in diagnostic samples was comparable to that observed in t(15;17) - associated APL, affording assay sensitivities of ∼1 in 10(4)-10(5). Serial samples were available from two PLZF-RARA APL patients. One showed persistent polymerase chain reaction positivity, predicting subsequent relapse, and remains in CR2, ∼11 years post-autograft. The other, achieved molecular remission (CRm) with combination chemotherapy, remaining in CR1 at 6 years. The STAT5b-RARA patient failed to achieve CRm following frontline combination chemotherapy and ultimately proceeded to allogeneic transplant on the basis of a steadily rising fusion transcript level. These data highlight the potential of RT-qPCR detection of MRD to facilitate development of more individualized approaches to the management of rarer molecularly defined subsets of acute leukemia.
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Affiliation(s)
- Jelena V. Jovanovic
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King’s College London School of MedicineLondon, UK
| | | | | | - Andrew Peniket
- Department of Haematology, John Radcliffe HospitalOxford, UK
| | - Anne Lennard
- Department of Haematology, Royal Victoria InfirmaryNewcastle, UK
| | - Justin Harrison
- Department of Haematology, Hemel Hempstead HospitalHemel Hempstead, UK
| | - Paresh Vyas
- Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular MedicineOxford, UK
| | - David Grimwade
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King’s College London School of MedicineLondon, UK
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