1
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Ozga M, Nicolet D, Mrózek K, Yilmaz AS, Kohlschmidt J, Larkin KT, Blachly JS, Oakes CC, Buss J, Walker CJ, Orwick S, Jurinovic V, Rothenberg-Thurley M, Dufour A, Schneider S, Sauerland MC, Görlich D, Krug U, Berdel WE, Woermann BJ, Hiddemann W, Braess J, Subklewe M, Spiekermann K, Carroll AJ, Blum WG, Powell BL, Kolitz JE, Moore JO, Mayer RJ, Larson RA, Uy GL, Stock W, Metzeler KH, Grimes HL, Byrd JC, Salomonis N, Herold T, Mims AS, Eisfeld AK. Sex-associated differences in frequencies and prognostic impact of recurrent genetic alterations in adult acute myeloid leukemia (Alliance, AMLCG). Leukemia 2024; 38:45-57. [PMID: 38017103 PMCID: PMC10776397 DOI: 10.1038/s41375-023-02068-8] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023]
Abstract
Clinical outcome of patients with acute myeloid leukemia (AML) is associated with demographic and genetic features. Although the associations of acquired genetic alterations with patients' sex have been recently analyzed, their impact on outcome of female and male patients has not yet been comprehensively assessed. We performed mutational profiling, cytogenetic and outcome analyses in 1726 adults with AML (749 female and 977 male) treated on frontline Alliance for Clinical Trials in Oncology protocols. A validation cohort comprised 465 women and 489 men treated on frontline protocols of the German AML Cooperative Group. Compared with men, women more often had normal karyotype, FLT3-ITD, DNMT3A, NPM1 and WT1 mutations and less often complex karyotype, ASXL1, SRSF2, U2AF1, RUNX1, or KIT mutations. More women were in the 2022 European LeukemiaNet intermediate-risk group and more men in adverse-risk group. We found sex differences in co-occurring mutation patterns and prognostic impact of select genetic alterations. The mutation-associated splicing events and gene-expression profiles also differed between sexes. In patients aged <60 years, SF3B1 mutations were male-specific adverse outcome prognosticators. We conclude that sex differences in AML-associated genetic alterations and mutation-specific differential splicing events highlight the importance of patients' sex in analyses of AML biology and prognostication.
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Affiliation(s)
- Michael Ozga
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA.
| | - Ayse S Yilmaz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karilyn T Larkin
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Christopher C Oakes
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Jill Buss
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Christopher J Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Shelley Orwick
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Vindi Jurinovic
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Annika Dufour
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute of Human Genetics, University Hospital, LMU Munich, Munich, Germany
| | | | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Utz Krug
- Department of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Wolfgang E Berdel
- Department of Medicine, Hematology and Oncology, University of Münster, Münster, Germany
| | | | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Marion Subklewe
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Bayard L Powell
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Joseph O Moore
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | | | - Geoffrey L Uy
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Stock
- University of Chicago Medical Center, Chicago, IL, USA
| | - Klaus H Metzeler
- Department of Hematology, Cellular Therapy, and Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | - H Leighton Grimes
- Division of Immunobiology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - John C Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Nathan Salomonis
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Biomedical Informatics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Alice S Mims
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA.
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2
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Bhatnagar B, Kohlschmidt J, Orwick SJ, Buelow DR, Fobare S, Oakes CC, Kolitz JE, Uy G, Stock W, Powell BL, Nicolet D, Hertlein EK, Mrózek K, Blachly JS, Eisfeld AK, Baker SD, Byrd JC. Framework of clonal mutations concurrent with WT1 mutations in adults with acute myeloid leukemia: Alliance for Clinical Trials in Oncology study. Blood Adv 2023; 7:4671-4675. [PMID: 37603350 PMCID: PMC10448419 DOI: 10.1182/bloodadvances.2023010482] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Bhavana Bhatnagar
- Department of Hematology and Medical Oncology, West Virginia University Cancer Institute, Wheeling Hospital, Wheeling, WV
| | - Jessica Kohlschmidt
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | - Shelley J. Orwick
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Daelynn R. Buelow
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Sydney Fobare
- Department of Internal Medicine, Medical Student Training Program, College of Medicine, The Ohio State University, Columbus, OH
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher C. Oakes
- Clara D. Bloomfield Center, The Ohio State Comprehensive Cancer Center, Columbus, OH
| | | | - Geoff Uy
- Division of Oncology, Department of Medicine, Washington University, St. Louis, MO
| | - Wendy Stock
- Division of Hematology-Oncology, Department of Internal Medicine, University of Chicago, Chicago, IL
| | - Bayard L. Powell
- Division of Hematology-Oncology, Department of Internal Medicine, Wake Forest University Health System, Winston-Salem, NC
| | - Deedra Nicolet
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | - Erin K. Hertlein
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Krzysztof Mrózek
- Clara D. Bloomfield Center, The Ohio State Comprehensive Cancer Center, Columbus, OH
| | - James S. Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Ann-Kathrin Eisfeld
- Clara D. Bloomfield Center, The Ohio State Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Sharyn D. Baker
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - John C. Byrd
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
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3
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Rebechi M, Kohlschmidt J, Mrózek K, Nicolet D, Mims AS, Blachly JS, Orwick S, Larkin KT, Oakes CC, Hantel A, Carroll AJ, Blum WG, Powell BL, Uy GL, Stone RM, Larson RA, Byrd JC, Paskett ED, Plascak JJ, Eisfeld AK. Association of social deprivation with survival in younger adult patients with AML: an Alliance study. Blood Adv 2023; 7:4019-4023. [PMID: 37196637 PMCID: PMC10425796 DOI: 10.1182/bloodadvances.2022009325] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 05/19/2023] Open
Affiliation(s)
- Melanie Rebechi
- Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jessica Kohlschmidt
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Krzysztof Mrózek
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Deedra Nicolet
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice S. Mims
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James S. Blachly
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Shelley Orwick
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Karilyn T. Larkin
- Department of Internal Medicine, The Ohio State University, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Christopher C. Oakes
- Department of Internal Medicine, The Ohio State University, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Andrew Hantel
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Andrew J. Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - William G. Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Bayard L. Powell
- Department of Internal Medicine, Section on Hematology and Oncology, Comprehensive Cancer Center of Wake Forest Baptist Health, Winston-Salem, NC
| | - Geoffrey L. Uy
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Richard M. Stone
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | | | - John C. Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Jesse J. Plascak
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Ann-Kathrin Eisfeld
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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4
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Bhatt VR, Ulrich AM, Uy GL, Stone RM, Stock W, Ojelabi MO, Yin J, Kohlschmidt J, Eisfeld AK, Baer MR, Chow S, Klepin H, Le-Rademacher J, Jatoi A. Outcomes of Older Adults With AML Treated in Community Versus Academic Centers: An Analysis of Alliance Trials. JCO Oncol Pract 2023:OP2200822. [PMID: 37058684 DOI: 10.1200/op.22.00822] [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: 04/16/2023] Open
Abstract
PURPOSE Clinical trials are important for managing older patients with AML. We investigated differences in outcomes of older patients with AML on the basis of whether patients participated in intensive chemotherapy trials at community versus academic cancer centers. METHODS We used data from the Alliance for Clinical Trials in Oncology phase III trials that enrolled patients age ≥ 60 years with newly diagnosed AML between 1998 and 2002 in the Cancer and Leukemia Group B (CALGB) 9720 trial and between 2004 and 2006 in the CALGB 10201 trial. Centers funded by the NCI Community Oncology Research Program were identified as community cancer centers; others were designated as academic cancer centers. Logistic regression models and Cox proportional hazards models were used to compare 1-month mortality and overall survival (OS) by center type. RESULTS Seventeen percent of the 1,170 patients were enrolled in clinical trials in community cancer centers. The study results demonstrated comparable rates of grade ≥3 adverse events (97% v 93%), 1-month mortality (19.1% v 16.1%), and OS (43.9% v 35.7% at 1 year) between community versus academic cancer centers, respectively. After adjusting for covariates, 1-month mortality (odds ratio, 1.40; 95% CI, 0.92 to 2.12; P = .11) and OS (hazard ratio, 1.04; 95% CI, 0.88 to 1.22; P = .67) were not statistically different among patients treated in community versus academic cancer centers. CONCLUSION An older patient population, who have complex health care needs, can be successfully treated on intensive chemotherapy trials in select community cancer centers with outcomes comparable with that achieved at academic cancer centers.
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Affiliation(s)
- Vijaya Raj Bhatt
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Angela M Ulrich
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Geoffrey L Uy
- Washington University School of Medicine, St Louis, MO
| | | | | | | | - Jun Yin
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Jessica Kohlschmidt
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ann-Kathrin Eisfeld
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Selina Chow
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | - Heidi Klepin
- Wake Forest University Health System, Winston-Salem, NC
| | - Jennifer Le-Rademacher
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
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5
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Mrózek K, Kohlschmidt J, Blachly JS, Nicolet D, Carroll AJ, Archer KJ, Mims AS, Larkin KT, Orwick S, Oakes CC, Kolitz JE, Powell BL, Blum WG, Marcucci G, Baer MR, Uy GL, Stock W, Byrd JC, Eisfeld AK. Outcome prediction by the 2022 European LeukemiaNet genetic-risk classification for adults with acute myeloid leukemia: an Alliance study. Leukemia 2023; 37:788-798. [PMID: 36823396 PMCID: PMC10079544 DOI: 10.1038/s41375-023-01846-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
Recently, the European LeukemiaNet (ELN) revised its genetic-risk classification of acute myeloid leukemia (AML). We categorized 1637 adults with AML treated with cytarabine/anthracycline regimens according to the 2022 and 2017 ELN classifications. Compared with the 2017 ELN classification, 2022 favorable group decreased from 40% to 35% and adverse group increased from 37% to 41% of patients. The 2022 genetic-risk groups seemed to accurately reflect treatment outcomes in all patients and patients aged <60 years, but in patients aged ≥60 years, relapse rates, disease-free (DFS) and overall (OS) survival were not significantly different between intermediate and adverse groups. In younger African-American patients, DFS and OS did not differ between intermediate-risk and adverse-risk patients nor did DFS between favorable and intermediate groups. In Hispanic patients, DFS and OS did not differ between favorable and intermediate groups. Outcome prediction abilities of 2022 and 2017 ELN classifications were similar. Among favorable-risk patients, myelodysplasia-related mutations did not affect patients with CEBPAbZIP mutations or core-binding factor AML, but changed risk assignment of NPM1-mutated/FLT3-ITD-negative patients to intermediate. NPM1-mutated patients with adverse-risk cytogenetic abnormalities were closer prognostically to the intermediate than adverse group. Our analyses both confirm and challenge prognostic significance of some of the newly added markers.
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Grants
- UG1 CA233180 NCI NIH HHS
- U10 CA180821 NCI NIH HHS
- UG1 CA189850 NCI NIH HHS
- UG1 CA189824 NCI NIH HHS
- P30 CA033572 NCI NIH HHS
- UG1 CA233247 NCI NIH HHS
- R35 CA197734 NCI NIH HHS
- UG1 CA233339 NCI NIH HHS
- P50 CA140158 NCI NIH HHS
- UG1 CA233331 NCI NIH HHS
- U10 CA180882 NCI NIH HHS
- UG1 CA233338 NCI NIH HHS
- U24 CA196171 NCI NIH HHS
- P30 CA016058 NCI NIH HHS
- UG1 CA233327 NCI NIH HHS
- Leukemia and Lymphoma Society (Leukemia & Lymphoma Society)
- Aptevo, Daiichi Sankyo, Glycomemetics, Kartos Pharmaceuticals, Xencor and Genentech
- U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- BLP is a consultant for Cornerstone Pharmaceuticals and reported research funding from Ambit Biosciences, Cornerstone, Genentech, Hoffman LaRoche, Jazz Pharmaceuticals, Novartis and Pfizer.
- WGB reported honoraria from Abbvie, Syndax, and AmerisourceBergen and research funding from Celyad Oncology, Nkarta, Xencor, Forma Therapeutics and Leukemia and Lymphoma Society.
- Agios Savvas Regional Cancer Hospital
- GLU is a consultant for AbbVie, Agios, Jazz, GlaxoSmithKline, Genentech, and Novartis; reported honoraria from Astellas and research funding from Macrogenics.
- JCB consults for Astellas, AstraZeneca, Novartis, Pharmacyclics, Syndax and Trillium; receives honoraria from Astellas, AstraZeneca, Novartis, Pharmacyclics, Syndax and Trillium; he is a Chairman of the Scientific Advisory Board of Vincerx Pharmaceuticals and a member of advisory committee of Newave; and is a current equity holder of Vincerx Pharmaceuticals.
- U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI)
- American Cancer Society (American Cancer Society, Inc.)
- Leukemia Research Foundation (LRF)
- Pelotonia
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Affiliation(s)
- Krzysztof Mrózek
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Jessica Kohlschmidt
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James S Blachly
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kellie J Archer
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alice S Mims
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karilyn T Larkin
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Shelley Orwick
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Christopher C Oakes
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Guido Marcucci
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Stock
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John C Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Ann-Kathrin Eisfeld
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- The Ohio State University, Department of Internal Medicine, Columbus, OH, USA.
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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6
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Hantel A, Kohlschmidt J, Eisfeld AK, Stock W, Jacobson S, Mandrekar S, Larson RA, Stone RM, Lathan CS, DeAngelo DJ, Byrd JC, Abel GA. Inequities in Alliance Acute Leukemia Clinical Trial and Biobank Participation: Defining Targets for Intervention. J Clin Oncol 2022; 40:3709-3718. [PMID: 35696629 PMCID: PMC9649272 DOI: 10.1200/jco.22.00307] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/08/2022] [Revised: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Representativeness in acute leukemia clinical research is essential for achieving health equity. The National Cancer Institute's mandate for Comprehensive Cancer Centers (CCCs) to define and assume responsibility for cancer control and treatment across a geographic catchment area provides an enforceable mechanism to target and potentially remediate participatory inequities. METHODS We examined enrollee characteristics across 15 Cancer and Leukemia Group B/Alliance cooperative group adult acute leukemia clinical trials (N = 3,734) from 1998 to 2013, including participation in optional companion biobanks. We determined enrollment odds by race-ethnicity for all participants adjusted for national incidence, and for those enrolled at CCCs adjusted for catchment area incidence. We modeled biobank participation by sociodemographics using logistic regression. RESULTS Non-Hispanic (NH)-White patients were more likely to be enrolled than NH-Black, NH-Asian, or Hispanic patients (odds ratio [OR], 0.75, 0.48, and 0.44, respectively; all P < .001), but less likely than NH-Native American patients (OR, 1.91; P < .001), adjusted for national incidence. Enrollment odds were lower for NH-Black, NH-Asian, and Hispanic patients at CCCs adjusted for catchment area incidence (OR, 0.57, 0.26, and 0.32, respectively; P < .001); differences were driven by overenrollment of NH-White patients from outside self-defined catchment areas (18.1% v 12.3%; χ2 P = .01) and by CCCs with less absolute enrollee diversity (rank sum P = .03). Among all enrollees, NH-White race-ethnicity and lower neighborhood deprivation correlated with biobank participation (OR, 1.81 and 1.45, respectively; P = .01 and .03). For CCC enrollees, the correlation of race-ethnicity with biobank participation was attenuated by a measure accounting for their site's degree of enrollment disparity but not neighborhood deprivation. CONCLUSION Acute leukemia clinical research disparities are substantial and driven by structural trial enrollment barriers at CCCs. Real-time CCC access and enrollment monitoring is needed to better align research participation with local populations.
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Affiliation(s)
| | - Jessica Kohlschmidt
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | | | - Wendy Stock
- The University of Chicago, Comprehensive Cancer Center, Chicago, IL
| | - Sawyer Jacobson
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Sumithra Mandrekar
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John C. Byrd
- University of Cincinnati, Cancer Center-UC Medical Center, Cincinnati, OH
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7
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Larkin KT, Nicolet D, Kelly BJ, Mrózek K, LaHaye S, Miller KE, Wijeratne S, Wheeler G, Kohlschmidt J, Blachly JS, Mims AS, Walker CJ, Oakes CC, Orwick S, Boateng I, Buss J, Heyrosa A, Desai H, Carroll AJ, Blum W, Powell BL, Kolitz JE, Moore JO, Mayer RJ, Larson RA, Stone RM, Paskett ED, Byrd JC, Mardis ER, Eisfeld AK. High early death rates, treatment resistance, and short survival of Black adolescents and young adults with AML. Blood Adv 2022; 6:5570-5581. [PMID: 35788257 PMCID: PMC9577622 DOI: 10.1182/bloodadvances.2022007544] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/10/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Survival of patients with acute myeloid leukemia (AML) is inversely associated with age, but the impact of race on outcomes of adolescent and young adult (AYA; range, 18-39 years) patients is unknown. We compared survival of 89 non-Hispanic Black and 566 non-Hispanic White AYA patients with AML treated on frontline Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols. Samples of 327 patients (50 Black and 277 White) were analyzed via targeted sequencing. Integrated genomic profiling was performed on select longitudinal samples. Black patients had worse outcomes, especially those aged 18 to 29 years, who had a higher early death rate (16% vs 3%; P=.002), lower complete remission rate (66% vs 83%; P=.01), and decreased overall survival (OS; 5-year rates: 22% vs 51%; P<.001) compared with White patients. Survival disparities persisted across cytogenetic groups: Black patients aged 18 to 29 years with non-core-binding factor (CBF)-AML had worse OS than White patients (5-year rates: 12% vs 44%; P<.001), including patients with cytogenetically normal AML (13% vs 50%; P<.003). Genetic features differed, including lower frequencies of normal karyotypes and NPM1 and biallelic CEBPA mutations, and higher frequencies of CBF rearrangements and ASXL1, BCOR, and KRAS mutations in Black patients. Integrated genomic analysis identified both known and novel somatic variants, and relative clonal stability at relapse. Reduced response rates to induction chemotherapy and leukemic clone persistence suggest a need for different treatment intensities and/or modalities in Black AYA patients with AML. Higher early death rates suggest a delay in diagnosis and treatment, calling for systematic changes to patient care.
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Affiliation(s)
- Karilyn T. Larkin
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Benjamin J. Kelly
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Stephanie LaHaye
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Katherine E. Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Saranga Wijeratne
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Gregory Wheeler
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James S. Blachly
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice S. Mims
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Christopher J. Walker
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Christopher C. Oakes
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Shelley Orwick
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Isaiah Boateng
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jill Buss
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Adrienne Heyrosa
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Helee Desai
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Andrew J. Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - William Blum
- Emory University School of Medicine, Atlanta, GA
| | - Bayard L. Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Jonathan E. Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY
| | - Joseph O. Moore
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Robert J. Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Richard M. Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
- The Center for Cancer Health Equity, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - John C. Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Elaine R. Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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8
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Papaioannou D, Ozer HG, Nicolet D, Urs AP, Herold T, Mrózek K, Batcha AMN, Metzeler KH, Yilmaz AS, Volinia S, Bill M, Kohlschmidt J, Pietrzak M, Walker CJ, Carroll AJ, Braess J, Powell BL, Eisfeld AK, Uy GL, Wang ES, Kolitz JE, Stone RM, Hiddemann W, Byrd JC, Bloomfield CD, Garzon R. Clinical and molecular relevance of genetic variants in the non-coding transcriptome of patients with cytogenetically normal acute myeloid leukemia. Haematologica 2021; 107:1034-1044. [PMID: 34261293 DOI: 10.3324/haematol.2021.266643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 11/09/2022] Open
Abstract
Expression levels of long non-coding RNAs (lncRNAs) have been shown to associate with clinical outcome of patients with cytogenetically normal acute myeloid leukemia (CN-AML). However, the frequency and clinical significance of genetic variants in the nucleotide sequences of lncRNAs in AML patients is unknown. Herein, we analyzed total RNA sequencing data of 377 younger adults (aged.
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Affiliation(s)
- Dimitrios Papaioannou
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, NYU Langone Health, New York
| | - Hatice G Ozer
- The Ohio State University, Department of Biomedical Informatics, Columbus
| | - Deedra Nicolet
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH; Alliance Statistics and Data Center, The Ohio State University, Comprehensive Cancer Center, Columbus
| | - Amog P Urs
- The Ohio State University, Comprehensive Cancer Center, Columbus
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), Munich
| | - Krzysztof Mrózek
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus
| | - Aarif M N Batcha
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany; Medical Data Integration Center (MeDIC), University Hospital, LMU Munich
| | - Klaus H Metzeler
- Department of Hematology, Cell Therapy and Hemostaseology, University Hospital Leipzig, Leipzig
| | - Ayse S Yilmaz
- The Ohio State University, Department of Biomedical Informatics, Columbus
| | - Stefano Volinia
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara
| | - Marius Bill
- The Ohio State University, Comprehensive Cancer Center, Columbus
| | - Jessica Kohlschmidt
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH; Alliance Statistics and Data Center, The Ohio State University, Comprehensive Cancer Center, Columbus
| | - Maciej Pietrzak
- The Ohio State University, Department of Biomedical Informatics, Columbus
| | - Christopher J Walker
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg
| | - Bayard L Powell
- The Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Ann-Kathrin Eisfeld
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus
| | - Geoffrey L Uy
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success
| | - Richard M Stone
- Dana-Farber Cancer Institute, Harvard University, Boston, MA
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg
| | - John C Byrd
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH; The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus
| | | | - Ramiro Garzon
- The Ohio State University, Comprehensive Cancer Center, Columbus.
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9
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Papaioannou D, Ozer HG, Nicolet D, Urs AP, Herold T, Mrózek K, Batcha AM, Metzeler KH, Yilmaz AS, Volinia S, Bill M, Kohlschmidt J, Pietrzak M, Walker CJ, Carroll AJ, Braess J, Powell BL, Eisfeld AK, Uy GL, Wang ES, Kolitz JE, Stone RM, Hiddemann W, Byrd JC, Bloomfield CD, Garzon R. Clinical and molecular relevance of genetic variants in the non-coding transcriptome of patients with cytogenetically normal acute myeloid leukemia. Haematologica 2021; 107. [PMID: 34261293 PMCID: PMC9052895 DOI: 10.3324/haematol.2020.266643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Expression levels of long non-coding RNA (lncRNA) have been shown to associate with clinical outcome of patients with cytogenetically normal acute myeloid leukemia (CN-AML). However, the frequency and clinical significance of genetic variants in the nucleotide sequences of lncRNA in AML patients is unknown. Herein, we analyzed total RNA sequencing data of 377 younger adults (aged <60 years) with CN-AML, who were comprehensively characterized with regard to clinical outcome. We used available genomic databases and stringent filters to annotate genetic variants unequivocally located in the non-coding transcriptome of AML patients. We detected 981 variants, which are recurrently present in lncRNA that are expressed in leukemic blasts. Among these variants, we identified a cytosine-to-thymidine variant in the lncRNA RP5-1074L1.4 and a cytosine-to-thymidine variant in the lncRNA SNHG15, which independently associated with longer survival of CN-AML patients. The presence of the SNHG15 cytosine-to-thymidine variant was also found to associate with better outcome in an independent dataset of CN-AML patients, despite differences in treatment protocols and RNA sequencing techniques. In order to gain biological insights, we cloned and overexpressed both wild-type and variant versions of the SNHG15 lncRNA. In keeping with its negative prognostic impact, overexpression of the wild-type SNHG15 associated with higher proliferation rate of leukemic blasts when compared with the cytosine-to-thymidine variant. We conclude that recurrent genetic variants of lncRNA that are expressed in the leukemic blasts of CN-AML patients have prognostic and potential biological significance.
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Affiliation(s)
- Dimitrios Papaioannou
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, NYU Langone Health, New York, NY, USA,*DP and HGO contributed equally as co-first authors
| | - Hatice G. Ozer
- The Ohio State University, Department of Biomedical Informatics, Columbus, OH, USA,*DP and HGO contributed equally as co-first authors
| | - Deedra Nicolet
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA,Alliance Statistics and Data Center, The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Amog P. Urs
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Krzysztof Mrózek
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Aarif M.N. Batcha
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany,Medical Data Integration Center (MeDIC), University Hospital, LMU Munich, Germany
| | - Klaus H. Metzeler
- Department of Hematology, Cell Therapy & Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Ayse S. Yilmaz
- The Ohio State University, Department of Biomedical Informatics, Columbus, OH, USA
| | - Stefano Volinia
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marius Bill
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Jessica Kohlschmidt
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA,Alliance Statistics and Data Center, The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Maciej Pietrzak
- The Ohio State University, Department of Biomedical Informatics, Columbus, OH, USA
| | - Christopher J. Walker
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Andrew J. Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Bayard L. Powell
- The Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Ann-Kathrin Eisfeld
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Geoffrey L. Uy
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Eunice S. Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jonathan E. Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Richard M. Stone
- Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | | | - John C. Byrd
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Clara D. Bloomfield
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,CDB and RG contributed equally as co-senior authors
| | - Ramiro Garzon
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA,CDB and RG contributed equally as co-senior authors
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10
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Bill M, Mrózek K, Giacopelli B, Kohlschmidt J, Nicolet D, Papaioannou D, Eisfeld AK, Kolitz JE, Powell BL, Carroll AJ, Stone RM, Garzon R, Byrd JC, Bloomfield CD, Oakes CC. Precision oncology in AML: validation of the prognostic value of the knowledge bank approach and suggestions for improvement. J Hematol Oncol 2021; 14:107. [PMID: 34229733 PMCID: PMC8261916 DOI: 10.1186/s13045-021-01118-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/25/2021] [Indexed: 12/18/2022] Open
Abstract
Recently, a novel knowledge bank (KB) approach to predict outcomes of individual patients with acute myeloid leukemia (AML) was developed using unbiased machine learning. To validate its prognostic value, we analyzed 1612 adults with de novo AML treated on Cancer and Leukemia Group B front-line trials who had pretreatment clinical, cytogenetics, and mutation data on 81 leukemia/cancer-associated genes available. We used receiver operating characteristic (ROC) curves and the area under the curve (AUC) to evaluate the predictive values of the KB algorithm and other risk classifications. The KB algorithm predicted 3-year overall survival (OS) probability in the entire patient cohort (AUCKB = 0.799), and both younger (< 60 years) (AUCKB = 0.747) and older patients (AUCKB = 0.770). The KB algorithm predicted non-remission death (AUCKB = 0.860) well but was less accurate in predicting relapse death (AUCKB = 0.695) and death in first complete remission (AUCKB = 0.603). The KB algorithm’s 3-year OS predictive value was higher than that of the 2017 European LeukemiaNet (ELN) classification (AUC2017ELN = 0.707, p < 0.001) and 2010 ELN classification (AUC2010ELN = 0.721, p < 0.001) but did not differ significantly from that of the 17-gene stemness score (AUC17-gene = 0.732, p = 0.10). Analysis of additional cytogenetic and molecular markers not included in the KB algorithm revealed that taking into account atypical complex karyotype, infrequent recurrent balanced chromosome rearrangements and mutational status of the SAMHD1, AXL and NOTCH1 genes may improve the KB algorithm. We conclude that the KB algorithm has a high predictive value that is higher than those of the 2017 and 2010 ELN classifications. Inclusion of additional genetic features might refine the KB algorithm.
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Affiliation(s)
- Marius Bill
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA. .,The Ohio State Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA. .,The Ohio State University Comprehensive Cancer Center, 444 Tzagournis Medical Research Facility, 420 West 12th Avenue, Columbus, OH, 43210-1228, USA.
| | - Brian Giacopelli
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,The Ohio State Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive, Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,The Ohio State Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive, Cancer Center, Columbus, OH, USA
| | - Dimitrios Papaioannou
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 400 West 12th Avenue, Wiseman Hall, Suite 455, Columbus, OH, 43210-1228, USA
| | - Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,The Ohio State Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 400 West 12th Avenue, Wiseman Hall, Suite 455, Columbus, OH, 43210-1228, USA
| | - Jonathan E Kolitz
- Zucker School of Medicine At Hofstra/Northwell, Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Richard M Stone
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 400 West 12th Avenue, Wiseman Hall, Suite 455, Columbus, OH, 43210-1228, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,The Ohio State Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 400 West 12th Avenue, Wiseman Hall, Suite 455, Columbus, OH, 43210-1228, USA
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 400 West 12th Avenue, Wiseman Hall, Suite 455, Columbus, OH, 43210-1228, USA
| | - Christopher C Oakes
- The Ohio State University Comprehensive Cancer Center, 460 West 12th Avenue, Columbus, OH, 43210-1228, USA. .,Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 400 West 12th Avenue, Wiseman Hall, Suite 455, Columbus, OH, 43210-1228, USA.
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11
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Mims AS, Kohlschmidt J, Borate U, Blachly JS, Orwick S, Eisfeld AK, Papaioannou D, Nicolet D, Mrόzek K, Stein E, Bhatnagar B, Stone RM, Kolitz JE, Wang ES, Powell BL, Burd A, Levine RL, Druker BJ, Bloomfield CD, Byrd JC. A precision medicine classification for treatment of acute myeloid leukemia in older patients. J Hematol Oncol 2021; 14:96. [PMID: 34162404 PMCID: PMC8220739 DOI: 10.1186/s13045-021-01110-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/04/2021] [Indexed: 01/22/2023] Open
Abstract
Background Older patients (≥ 60 years) with acute myeloid leukemia (AML) often have multiple, sequentially acquired, somatic mutations that drive leukemogenesis and are associated with poor outcome. Beat AML is a Leukemia and Lymphoma Society-sponsored, multicenter umbrella study that algorithmically segregates AML patients based upon cytogenetic and dominant molecular abnormalities (variant allele frequencies (VAF) ≥ 0.2) into different cohorts to select for targeted therapies. During the conception of the Beat AML design, a historical dataset was needed to help in the design of the genomic algorithm for patient assignment and serve as the basis for the statistical design of individual genomic treatment substudies for the Beat AML study. Methods We classified 563 newly diagnosed older AML patients treated with standard intensive chemotherapy on trials conducted by Cancer and Leukemia Group B based on the same genomic algorithm and assessed clinical outcomes. Results Our classification identified core-binding factor and NPM1-mutated/FLT3-ITD-negative groups as having the best outcomes, with 30-day early death (ED) rates of 0 and 20%, respectively, and median overall survival (OS) of > 1 year and 3-year OS rates of ≥ 20%. All other genomic groups had ED rates of 17–42%, median OS ≤ 1 year and 3-year OS rates of ≤ 15%. Conclusions By classifying patients through this genomic algorithm, outcomes were poor and not unexpected from a non-algorithmic, non-dominant VAF approach. The exception is 30-day ED rate typically is not available for intensive induction for individual genomic groups and therefore difficult to compare outcomes with targeted therapeutics. This Alliance data supported the use of this algorithm for patient assignment at the initiation of the Beat AML study. This outcome data was also used for statistical design for Beat AML substudies for individual genomic groups to determine goals for improvement from intensive induction and hopefully lead to more rapid approval of new therapies. Trial registration ClinicalTrials.gov Identifiers: NCT00048958 (CALGB 8461), NCT00900224 (CALGB 20202), NCT00003190 (CALGB 9720), NCT00085124 (CALGB 10201), NCT00742625 (CALGB 10502), NCT01420926 (CALGB 11002), NCT00039377 (CALGB 10801), and NCT01253070 (CALGB 11001). Supplementary Information The online version contains supplementary material available at 10.1186/s13045-021-01110-5.
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Affiliation(s)
- Alice S Mims
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA.
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Uma Borate
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA
| | - Shelley Orwick
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA
| | - Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA.,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Dimitrios Papaioannou
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Krzysztof Mrόzek
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA.,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Eytan Stein
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhavana Bhatnagar
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA
| | | | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Amy Burd
- The Leukemia and Lymphoma Society, White Plains, NY, USA
| | - Ross L Levine
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall B302, Columbus, OH, 43210, USA. .,The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA. .,The Ohio State University Comprehensive Cancer Center, 455 CCC Wiseman Hall, 400 West 12th Avenue, Columbus, OH, 43210-1228, USA.
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12
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Bhatnagar B, Kohlschmidt J, Mrózek K, Zhao Q, Fisher JL, Nicolet D, Walker CJ, Mims AS, Oakes C, Giacopelli B, Orwick S, Boateng I, Blachly JS, Maharry SE, Carroll AJ, Powell BL, Kolitz JE, Stone RM, Byrd JC, Paskett ED, de la Chapelle A, Garzon R, Eisfeld AK. Poor Survival and Differential Impact of Genetic Features of Black Patients with Acute Myeloid Leukemia. Cancer Discov 2021; 11:626-637. [PMID: 33277314 PMCID: PMC7933110 DOI: 10.1158/2159-8290.cd-20-1579] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 10/30/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
Clinical outcome of patients with acute myeloid leukemia (AML) is associated with cytogenetic and molecular factors and patient demographics (e.g., age and race). We compared survival of 25,523 non-Hispanic Black and White adults with AML using Surveillance Epidemiology and End Results (SEER) Program data and performed mutational profiling of 1,339 patients with AML treated on frontline Alliance for Clinical Trials in Oncology (Alliance) protocols. Black patients had shorter survival than White patients, both in SEER and in the setting of Alliance clinical trials. The disparity was especially pronounced in Black patients <60 years, after adjustment for socioeconomic (SEER) and molecular (Alliance) factors. Black race was an independent prognosticator of poor survival. Gene mutation profiles showed fewer NPM1 and more IDH2 mutations in younger Black patients. Overall survival of younger Black patients was adversely affected by IDH2 mutations and FLT3-ITD, but, in contrast to White patients, was not improved by NPM1 mutations. SIGNIFICANCE: We show that young Black patients have not benefited as much as White patients from recent progress in AML treatment in the United States. Our data suggest that both socioeconomic factors and differences in disease biology contribute to the survival disparity and need to be urgently addressed.See related commentary by Vyas, p. 540.This article is highlighted in the In This Issue feature, p. 521.
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MESH Headings
- Adolescent
- Adult
- Black or African American/genetics
- Aged
- Aged, 80 and over
- Biomarkers, Tumor
- Disease Management
- Disease Susceptibility
- Female
- Genetic Background
- Humans
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Mutation
- Outcome Assessment, Health Care
- Prognosis
- Public Health Surveillance
- Registries
- Risk Factors
- SEER Program
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Bhavana Bhatnagar
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, Ohio
- Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, Ohio
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - James L Fisher
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, Ohio
- Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Christopher J Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, Ohio
| | - Alice S Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Christopher Oakes
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Brian Giacopelli
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Shelley Orwick
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Isaiah Boateng
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Sophia E Maharry
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, Ohio
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, Ohio
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13
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Ustun C, Morgan EA, Ritz EM, Vestergaard H, Pullarkat S, Kluin PM, Ohgami R, Baughn LB, Kim Y, Ku NK, Czuchlewski D, Boe Møller M, Schiefer AI, Mrózek K, Horny HP, George TI, Kielsgaard Kristensen T, Beck T, Nathan S, Arana Yi C, Yeung C, Pullarkat V, Gotlib J, Akin C, Kohlschmidt J, Salhotra A, Soma L, Chen D, Han SY, Cho C, Sperr W, Broesby-Olsen S, Linden MA, Dolan M, Hoermann G, Hornick JL, Bloomfield C, Nakamura R, Joachim Deeg H, Litzow MR, Borthakur G, Weisdorf D, Huls G, Perales MA, Valent P, Marcucci G. Core-binding factor acute myeloid leukemia with inv(16): Older age and high white blood cell count are risk factors for treatment failure. Int J Lab Hematol 2020; 43:e19-e25. [PMID: 32926565 DOI: 10.1111/ijlh.13338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Celalettin Ustun
- Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA.,Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ethan M Ritz
- Rush Bioinformatics and Biostatistics Core, Rush University, Chicago, IL, USA
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Sheeja Pullarkat
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Philip M Kluin
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert Ohgami
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Linda B Baughn
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Young Kim
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Nam K Ku
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - David Czuchlewski
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Michael Boe Møller
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark.,Mastocytosis Center Odense University Hospital, Odense, Denmark
| | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Tracy I George
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Thomas Kielsgaard Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Mastocytosis Center, Odense University Hospital, Odense, Denmark
| | - Todd Beck
- Rush Bioinformatics and Biostatistics Core, Rush University, Chicago, IL, USA
| | - Sunita Nathan
- Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA
| | - Cecilia Arana Yi
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Cecilia Yeung
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Vinod Pullarkat
- Division of Hematology and HCT, City of Hope, Duarte, CA, USA
| | - Jason Gotlib
- Stanford Cancer Institute, School of Medicine, Stanford University, Stanford, CA, USA
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Amandeep Salhotra
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Lori Soma
- University of Washington School of Medicine, Seattle, WA, USA
| | - Dong Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Se Y Han
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Christina Cho
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Wolfgang Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Sigurd Broesby-Olsen
- Mastocytosis Center Odense University Hospital, Odense, Denmark.,Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense, Denmark
| | - Michael A Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Michelle Dolan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Gregor Hoermann
- Division of Medical and Chemical Laboratory Diagnostics - Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clara Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ryo Nakamura
- Division of Hematology and HCT, City of Hope, Duarte, CA, USA
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Mark R Litzow
- Department of Internal Medicine and Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Gautam Borthakur
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Guido Marcucci
- Division of Hematology and HCT, City of Hope, Duarte, CA, USA
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14
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Eisfeld AK, Kohlschmidt J, Mims A, Nicolet D, Walker CJ, Blachly JS, Carroll AJ, Papaioannou D, Kolitz JE, Powell BE, Stone RM, de la Chapelle A, Byrd JC, Mrózek K, Bloomfield CD. Additional gene mutations may refine the 2017 European LeukemiaNet classification in adult patients with de novo acute myeloid leukemia aged <60 years. Leukemia 2020; 34:3215-3227. [PMID: 32461631 DOI: 10.1038/s41375-020-0872-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
The European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) have become an important tool to assess patients' prognosis and guide treatment. We tested the prognostic impact of the 2017 ELN classification in a large cohort of 863 AML patients aged <60 years similarly treated on Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology studies. Based on multivariable models within each ELN genetic-risk group, we identified additional gene mutations that may refine the 2017 ELN risk classification. BCOR- or SETBP1-mutated favorable-risk patients with non-core-binding factor AML and IDH-mutated adverse-risk patients had intermediate-risk outcomes. Outcomes of NPM1/WT1 co-mutated patients and those of ZRSR2-mutated patients resembled outcome of adverse-risk patients. Moreover, FLT3-ITDhigh allelic ratio conferred adverse rather than intermediate-risk irrespective of the NPM1 mutation status, and DNMT3A mutations associated with very poor survival. Application of these refinements reclassified 9% of current favorable-risk patients and 53% of current intermediate-risk patients to the adverse-risk group, with similar poor survival as current adverse-risk patients. Furthermore, 4% of current favorable-risk patients and 9% of adverse-risk patients were reclassified to the intermediate-risk group.
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Affiliation(s)
- Ann-Kathrin Eisfeld
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University, Columbus, OH, USA
| | - Alice Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University, Columbus, OH, USA
| | | | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Dimitrios Papaioannou
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Bayard E Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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15
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Papaioannou D, Volinia S, Nicolet D, Świerniak M, Petri A, Mrózek K, Bill M, Pepe F, Walker CJ, Walker AE, Carroll AJ, Kohlschmidt J, Eisfeld AK, Powell BL, Uy GL, Kolitz JE, Wang ES, Kauppinen S, Dorrance A, Stone RM, Byrd JC, Bloomfield CD, Garzon R. Clinical and functional significance of circular RNAs in cytogenetically normal AML. Blood Adv 2020; 4:239-251. [PMID: 31945158 PMCID: PMC6988408 DOI: 10.1182/bloodadvances.2019000568] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 06/10/2019] [Accepted: 11/14/2019] [Indexed: 01/08/2023] Open
Abstract
Circular RNAs (circRNAs) are noncoding RNA molecules that display a perturbed arrangement of exons, called backsplicing. To examine the prognostic and biologic significance of circRNA expression in cytogenetically normal acute myeloid leukemia (CN-AML), we conducted whole-transcriptome profiling in 365 younger adults (age 18-60 years) with CN-AML. We applied a novel pipeline, called Massive Scan for circRNA, to identify and quantify circRNA expression. We validated the high sensitivity and specificity of our pipeline by performing RNase R treatment and RNA sequencing in samples of AML patients and cell lines. Unsupervised clustering analyses identified 3 distinct circRNA expression-based clusters with different frequencies of clinical and molecular features. After dividing our cohort into training and validation data sets, we identified 4 circRNAs (circCFLAR, circKLHL8, circSMC1A, and circFCHO2) that were prognostic in both data sets; high expression of each prognostic circRNA was associated with longer disease-free, overall, and event-free survival. In multivariable analyses, high circKLHL8 and high circFCHO2 expression were independently associated with better clinical outcome of CN-AML patients, after adjusting for other covariates. To examine the biologic relevance of circRNA expression, we performed knockdown screening experiments in a subset of prognostic and gene mutation-related candidate circRNAs. We identified circFBXW7, but not its linear messenger RNA, as a regulator of the proliferative capacity of AML blasts. In summary, our findings underscore the molecular associations, prognostic significance, and functional relevance of circRNA expression in CN-AML.
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Affiliation(s)
| | - Stefano Volinia
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, The Ohio State University, Columbus, OH
| | - Michał Świerniak
- Centre of New Technologies, University of Warsaw, Warsaw, Poland
| | - Andreas Petri
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Marius Bill
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Felice Pepe
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Allison E Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, The Ohio State University, Columbus, OH
| | | | - Bayard L Powell
- The Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Geoffrey L Uy
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY
| | - Eunice S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; and
| | - Sakari Kauppinen
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | | | - Richard M Stone
- Dana-Farber Cancer Institute, Harvard University, Boston, MA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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16
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Papaioannou D, Petri A, Dovey OM, Terreri S, Wang E, Collins FA, Woodward LA, Walker AE, Nicolet D, Pepe F, Kumchala P, Bill M, Walker CJ, Karunasiri M, Mrózek K, Gardner ML, Camilotto V, Zitzer N, Cooper JL, Cai X, Rong-Mullins X, Kohlschmidt J, Archer KJ, Freitas MA, Zheng Y, Lee RJ, Aifantis I, Vassiliou G, Singh G, Kauppinen S, Bloomfield CD, Dorrance AM, Garzon R. Publisher Correction: The long non-coding RNA HOXB-AS3 regulates ribosomal RNA transcription in NPM1-mutated acute myeloid leukemia. Nat Commun 2020; 11:204. [PMID: 31911614 PMCID: PMC6946642 DOI: 10.1038/s41467-019-13969-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Andreas Petri
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Oliver M Dovey
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - Sara Terreri
- Institute of Genetics and Biophysics (IGB-ABT), National Council of Research (CNR), Naples, Italy
| | - Eric Wang
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Frances A Collins
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Lauren A Woodward
- Department of Molecular Genetics, Center for RNA Biology, The Ohio State University, Columbus, OH, USA
| | - Allison E Walker
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, The Ohio State University, Columbus, OH, USA
| | - Felice Pepe
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Prasanthi Kumchala
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Marius Bill
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Malith Karunasiri
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Miranda L Gardner
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.,Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Virginia Camilotto
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Nina Zitzer
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Jonathan L Cooper
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - Xiongwei Cai
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Xiaoqing Rong-Mullins
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.,Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jessica Kohlschmidt
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, The Ohio State University, Columbus, OH, USA
| | - Kellie J Archer
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.,Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Michael A Freitas
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.,Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Yi Zheng
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Robert J Lee
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Iannis Aifantis
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - George Vassiliou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK.,Department of Haematology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Guramrit Singh
- Department of Molecular Genetics, Center for RNA Biology, The Ohio State University, Columbus, OH, USA
| | - Sakari Kauppinen
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Clara D Bloomfield
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Ramiro Garzon
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.
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17
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Papaioannou D, Petri A, Dovey OM, Terreri S, Wang E, Collins FA, Woodward LA, Walker AE, Nicolet D, Pepe F, Kumchala P, Bill M, Walker CJ, Karunasiri M, Mrózek K, Gardner ML, Camilotto V, Zitzer N, Cooper JL, Cai X, Rong-Mullins X, Kohlschmidt J, Archer KJ, Freitas MA, Zheng Y, Lee RJ, Aifantis I, Vassiliou G, Singh G, Kauppinen S, Bloomfield CD, Dorrance AM, Garzon R. The long non-coding RNA HOXB-AS3 regulates ribosomal RNA transcription in NPM1-mutated acute myeloid leukemia. Nat Commun 2019; 10:5351. [PMID: 31767858 PMCID: PMC6877618 DOI: 10.1038/s41467-019-13259-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 08/06/2018] [Accepted: 10/28/2019] [Indexed: 12/21/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) are important regulatory molecules that are implicated in cellular physiology and pathology. In this work, we dissect the functional role of the HOXB-AS3 lncRNA in patients with NPM1-mutated (NPM1mut) acute myeloid leukemia (AML). We show that HOXB-AS3 regulates the proliferative capacity of NPM1mut AML blasts in vitro and in vivo. HOXB-AS3 is shown to interact with the ErbB3-binding protein 1 (EBP1) and guide EBP1 to the ribosomal DNA locus. Via this mechanism, HOXB-AS3 regulates ribosomal RNA transcription and de novo protein synthesis. We propose that in the context of NPM1 mutations, HOXB-AS3 overexpression acts as a compensatory mechanism, which allows adequate protein production in leukemic blasts.
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MESH Headings
- Acute Disease
- Animals
- Cell Line, Tumor
- Cell Proliferation
- HEK293 Cells
- Humans
- K562 Cells
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Mice, Inbred NOD
- Mice, Knockout
- Mice, SCID
- Mutation
- Nuclear Proteins/genetics
- Nucleophosmin
- Protein Biosynthesis/genetics
- RNA, Long Noncoding/genetics
- RNA, Ribosomal/genetics
- THP-1 Cells
- Transcription, Genetic
- Transplantation, Heterologous
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Affiliation(s)
| | - Andreas Petri
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Oliver M Dovey
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - Sara Terreri
- Institute of Genetics and Biophysics (IGB-ABT), National Council of Research (CNR), Naples, Italy
| | - Eric Wang
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Frances A Collins
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Lauren A Woodward
- Department of Molecular Genetics, Center for RNA Biology, The Ohio State University, Columbus, OH, USA
| | - Allison E Walker
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
- Alliance for Clinical Trials in Oncology Statistics and Data Center, The Ohio State University, Columbus, OH, USA
| | - Felice Pepe
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Prasanthi Kumchala
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Marius Bill
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Malith Karunasiri
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Miranda L Gardner
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Virginia Camilotto
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Nina Zitzer
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | - Jonathan L Cooper
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - Xiongwei Cai
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Xiaoqing Rong-Mullins
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jessica Kohlschmidt
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
- Alliance for Clinical Trials in Oncology Statistics and Data Center, The Ohio State University, Columbus, OH, USA
| | - Kellie J Archer
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Michael A Freitas
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Yi Zheng
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Robert J Lee
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Iannis Aifantis
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - George Vassiliou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
- Department of Haematology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Guramrit Singh
- Department of Molecular Genetics, Center for RNA Biology, The Ohio State University, Columbus, OH, USA
| | - Sakari Kauppinen
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Clara D Bloomfield
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Ramiro Garzon
- The Ohio State University, Comprehensive Cancer Center, Columbus, OH, USA.
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18
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Bill M, Nicolet D, Kohlschmidt J, Walker CJ, Mrózek K, Eisfeld AK, Papaioannou D, Rong-Mullins X, Brannan Z, Kolitz JE, Powell BL, Archer KJ, Dorrance AM, Carroll AJ, Stone RM, Byrd JC, Garzon R, Bloomfield CD. Mutations associated with a 17-gene leukemia stem cell score and the score's prognostic relevance in the context of the European LeukemiaNet classification of acute myeloid leukemia. Haematologica 2019; 105:721-729. [PMID: 31413100 PMCID: PMC7049376 DOI: 10.3324/haematol.2019.225003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/19/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
Leukemia stem cells (LSC) are more resistant to standard chemotherapy and their persistence during remission can cause relapse, which is still one of the major clinical challenges in the treatment of acute myeloid leukemia (AML). A better understanding of the mutational patterns and the prognostic impact of molecular markers associated with stemness could lead to better clinical management and improve patients’ outcomes. We applied a previously described 17-gene expression score comprising genes differently expressed between LSC and leukemic bulk blasts, for 934 adult patients with de novo AML, and studied associations of the 17-gene LSC score with clinical data and mutation status of 81 genes recurrently mutated in cancer and leukemia. We found that patients with a high 17-gene score were older and had more mutations. The 17-gene score was found to have a prognostic impact in both younger (aged <60 years) and older (aged ≥60 years) patients with AML. We also analyzed the 17-gene LSC score in the context of the 2017 European LeukemiaNet genetic-risk classification and found that for younger patients the score refined the classification, and identified patients currently classified in the European LeukemiaNet Favorable-risk category who had a worse outcome.
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Affiliation(s)
- Marius Bill
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Zachary Brannan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY
| | - Bayard L Powell
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Kellie J Archer
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,College of Public Health, The Ohio State University, Columbus, OH
| | - Adrienne M Dorrance
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH .,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
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19
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Walker CJ, Kohlschmidt J, Eisfeld AK, Mrózek K, Liyanarachchi S, Song C, Nicolet D, Blachly JS, Bill M, Papaioannou D, Oakes CC, Giacopelli B, Genutis LK, Maharry SE, Orwick S, Archer KJ, Powell BL, Kolitz JE, Uy GL, Wang ES, Carroll AJ, Stone RM, Byrd JC, de la Chapelle A, Bloomfield CD. Genetic Characterization and Prognostic Relevance of Acquired Uniparental Disomies in Cytogenetically Normal Acute Myeloid Leukemia. Clin Cancer Res 2019; 25:6524-6531. [PMID: 31375516 DOI: 10.1158/1078-0432.ccr-19-0725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/06/2019] [Accepted: 07/30/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Uniparental disomy (UPD) is a way cancer cells duplicate a mutated gene, causing loss of heterozygosity (LOH). Patients with cytogenetically normal acute myeloid leukemia (CN-AML) do not have microscopically detectable chromosome abnormalities, but can harbor UPDs. We examined the prognostic significance of UPDs and frequency of LOH in patients with CN-AML.Experimental Design: We examined the frequency and prognostic significance of UPDs in a set of 425 adult patients with de novo CN-AML who were previously sequenced for 81 genes typically mutated in cancer. Associations of UPDs with outcome were analyzed in the 315 patients with CN-AML younger than 60 years. RESULTS We detected 127 UPDs in 109 patients. Most UPDs were large and typically encompassed all or most of the affected chromosome arm. The most common UPDs occurred on chromosome arms 13q (7.5% of patients), 6p (2.8%), and 11p (2.8%). Many UPDs significantly cooccurred with mutations in genes they encompassed, including 13q UPD with FLT3-internal tandem duplication (FLT3-ITD; P < 0.001), and 11p UPD with WT1 mutations (P = 0.02). Among patients younger than 60 years, UPD of 11p was associated with longer overall survival (OS) and 13q UPD with shorter disease-free survival (DFS) and OS. In multivariable models that accounted for known prognostic markers, including FLT3-ITD and WT1 mutations, UPD of 13q maintained association with shorter DFS, and UPD of 11p maintained association with longer OS. CONCLUSIONS LOH mediated by UPD is a recurrent feature of CN-AML. Detection of UPDs of 13q and 11p might be useful for genetic risk stratification of patients with CN-AML.
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Affiliation(s)
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Chi Song
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Marius Bill
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | | | - Brian Giacopelli
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Luke K Genutis
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Sophia E Maharry
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Shelley Orwick
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Kellie J Archer
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Jonathan E Kolitz
- Monter Cancer Center, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Geoffrey L Uy
- Washington University School of Medicine in St. Louis, Siteman Cancer Center, St. Louis, Missouri
| | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | | | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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20
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Papaioannou D, Nicolet D, Ozer HG, Mrózek K, Volinia S, Fadda P, Carroll AJ, Kohlschmidt J, Kolitz JE, Wang ES, Stone RM, Byrd JC, Garzon R, Bloomfield CD. Prognostic and Biologic Relevance of Clinically Applicable Long Noncoding RNA Profiling in Older Patients with Cytogenetically Normal Acute Myeloid Leukemia. Mol Cancer Ther 2019; 18:1451-1459. [PMID: 31164409 DOI: 10.1158/1535-7163.mct-18-1125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/29/2019] [Accepted: 05/30/2019] [Indexed: 01/22/2023]
Abstract
We have previously shown that expression levels of 48 long noncoding RNAs (lncRNA) can generate a prognostic lncRNA score that independently associates with outcome of older patients with cytogenetically normal acute myeloid leukemia (CN-AML). However, the techniques used to identify and measure prognostic lncRNAs (i.e., RNA sequencing and microarrays) are not tailored for clinical testing. Herein, we report on an assay (based on the nCounter platform) that is designed to produce targeted measurements of prognostic lncRNAs in a clinically applicable manner. We analyzed a new cohort of 76 older patients with CN-AML and found that the nCounter assay yielded reproducible measurements and that the lncRNA score retained its prognostic value; patients with high lncRNA scores had lower complete remission (CR) rates (P = 0.009; 58% vs. 87%), shorter disease-free (P = 0.05; 3-year rates: 0% vs. 21%), overall (OS; P = 0.02, 3-year rates: 10% vs. 29%), and event-free survival (EFS; P = 0.002, 3-year rates: 0% vs. 18%) than patients with low lncRNA scores. In multivariable analyses, the lncRNA score independently associated with CR rates (P = 0.02), OS (P = 0.02), and EFS (P = 0.02). To gain biological insights, we examined our initial cohort of 71 older patients with CN-AML, previously analyzed with RNA sequencing. Genes involved in immune response and B-cell receptor signaling were enriched in patients with high lncRNA scores. We conclude that clinically applicable lncRNA profiling is feasible and potentially useful for risk stratification of older patients with CN-AML. Furthermore, we identify potentially targetable molecular pathways that are active in the high-risk patients with high lncRNA scores.
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Affiliation(s)
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, The Ohio State University, Columbus, Ohio
| | - Hatice G Ozer
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Stefano Volinia
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Paolo Fadda
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, The Ohio State University, Columbus, Ohio
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Richard M Stone
- Dana-Farber/Partners Cancer Care, Harvard University, Boston, Massachusetts
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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21
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Bill M, Papaioannou D, Karunasiri M, Kohlschmidt J, Pepe F, Walker CJ, Walker AE, Brannan Z, Pathmanathan A, Zhang X, Mrózek K, LaRocco A, Volinia S, Bloomfield CD, Garzon R, Dorrance AM. Expression and functional relevance of long non-coding RNAs in acute myeloid leukemia stem cells. Leukemia 2019; 33:2169-2182. [PMID: 30858548 DOI: 10.1038/s41375-019-0429-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 02/08/2023]
Abstract
In acute myeloid leukemia (AML), novel therapies are needed to target not only the rapidly dividing AML blasts but also the distinct population of leukemia stem cells (LSCs), which have abnormal self-renewal capacity and increased chemotherapy resistance. Elucidation of the expression and function of deregulated genes in LSCs is critical to specifically target LSCs and may consequently lead to improving outcomes of AML patients. Here, we correlated long non-coding RNA (lncRNA) expression profiles obtained from two RNA-seq datasets of 375 younger (aged <60 years) 76 older (≥60 years) adults with cytogenetically normal AML with a 'core enriched' (CE) gene expression signature (GES) associated with LSCs. We identified a LSC-specific signature of 111 lncRNAs that correlated strongly with the CE-GES. Among the top upregulated LSC-associated lncRNAs, we identified the lncRNA DANCR. Further experiments confirmed that DANCR is upregulated in functionally validated LSC-enriched populations. DANCR knock-down in LSCs resulted in decreased stem-cell renewal and quiescence. Furthermore, we showed that targeting Dancr in vivo using a primary murine model of AML (expressing both Mll partial tandem duplication/Flt3 internal tandem duplication) prolonged the survival of mice after serial transplantation. Our data suggest that LSCs have a distinct lncRNA signature with functional relevance and therapeutic potential.
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Affiliation(s)
- Marius Bill
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Malith Karunasiri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Felice Pepe
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Allison E Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Zachary Brannan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Xiaoli Zhang
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Allison LaRocco
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Stefano Volinia
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. .,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
| | - Adrienne M Dorrance
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. .,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
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22
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Mrózek K, Eisfeld AK, Kohlschmidt J, Carroll AJ, Walker CJ, Nicolet D, Blachly JS, Bill M, Papaioannou D, Wang ES, Uy GL, Kolitz JE, Powell BL, Blum W, Stone RM, Byrd JC, Bloomfield CD. Complex karyotype in de novo acute myeloid leukemia: typical and atypical subtypes differ molecularly and clinically. Leukemia 2019; 33:1620-1634. [PMID: 30737482 PMCID: PMC6609457 DOI: 10.1038/s41375-019-0390-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/17/2018] [Accepted: 01/09/2019] [Indexed: 02/04/2023]
Abstract
Complex karyotype (CK) with ≥3 abnormalities is detected in 10-12% of patients with acute myeloid leukemia (AML) and associated with poor prognosis. The most common unbalanced abnormalities found in CK result in loss of material from the 5q, 7q and/or 17p chromosome arms. The presence of 5q, 7q and/or 17p abnormalities denotes typical CK and their absence denotes atypical CK. Since molecular features of CK-AML are not well-characterized, we investigated mutational status of 81 leukemia/cancer-associated genes in 160 clinically well-characterized patients. They included 136 patients with ≥3 exclusively unbalanced chromosome abnormalities, 96 of whom had a typical CK and 40 atypical CK, and 24 patients with ≥1 balanced abnormality in addition to ≥2 unbalanced ones. Patients with atypical CK-AML differed from those with typical CK-AML: they carried TP53 mutations less often (P<0.001) and more often PHF6 (P=0.008), FLT3-TKD (P=0.02), MED12 (P=0.02) and NPM1 (P=0.02) mutations. They were younger (P=0.007), had higher WBC (P=0.001) and percentages of marrow (P<0.001) and blood (P=0.006) blasts, higher complete remission rates (P=0.02) and longer overall survival (P<0.001), thus indicating that atypical and typical CK-AMLs constitute distinct disease subtypes. We also identified smaller patient subsets within both typical and atypical CK-AML that differed molecularly and clinically.
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Affiliation(s)
- Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | | | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Marius Bill
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Eunice S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Geoffrey L Uy
- Washington University School of Medicine in St. Louis, Siteman Cancer Center, St. Louis, MO, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - William Blum
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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23
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Gu Z, Churchman ML, Roberts KG, Moore I, Zhou X, Nakitandwe J, Hagiwara K, Pelletier S, Gingras S, Berns H, Payne-Turner D, Hill A, Iacobucci I, Shi L, Pounds S, Cheng C, Pei D, Qu C, Newman S, Devidas M, Dai Y, Reshmi SC, Gastier-Foster J, Raetz EA, Borowitz MJ, Wood BL, Carroll WL, Zweidler-McKay PA, Rabin KR, Mattano LA, Maloney KW, Rambaldi A, Spinelli O, Radich JP, Minden MD, Rowe JM, Luger S, Litzow MR, Tallman MS, Racevskis J, Zhang Y, Bhatia R, Kohlschmidt J, Mrózek K, Bloomfield CD, Stock W, Kornblau S, Kantarjian HM, Konopleva M, Evans WE, Jeha S, Pui CH, Yang J, Paietta E, Downing JR, Relling MV, Zhang J, Loh ML, Hunger SP, Mullighan CG. PAX5-driven subtypes of B-progenitor acute lymphoblastic leukemia. Nat Genet 2019; 51:296-307. [PMID: 30643249 DOI: 10.1038/s41588-018-0315-5] [Citation(s) in RCA: 329] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022]
Abstract
Recent genomic studies have identified chromosomal rearrangements defining new subtypes of B-progenitor acute lymphoblastic leukemia (B-ALL), however many cases lack a known initiating genetic alteration. Using integrated genomic analysis of 1,988 childhood and adult cases, we describe a revised taxonomy of B-ALL incorporating 23 subtypes defined by chromosomal rearrangements, sequence mutations or heterogeneous genomic alterations, many of which show marked variation in prevalence according to age. Two subtypes have frequent alterations of the B lymphoid transcription-factor gene PAX5. One, PAX5alt (7.4%), has diverse PAX5 alterations (rearrangements, intragenic amplifications or mutations); a second subtype is defined by PAX5 p.Pro80Arg and biallelic PAX5 alterations. We show that p.Pro80Arg impairs B lymphoid development and promotes the development of B-ALL with biallelic Pax5 alteration in vivo. These results demonstrate the utility of transcriptome sequencing to classify B-ALL and reinforce the central role of PAX5 as a checkpoint in B lymphoid maturation and leukemogenesis.
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Affiliation(s)
- Zhaohui Gu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michelle L Churchman
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathryn G Roberts
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ian Moore
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xin Zhou
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joy Nakitandwe
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kohei Hagiwara
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephane Pelletier
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sebastien Gingras
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hartmut Berns
- Department of Transgenic/Gene Knockout Shared Resource, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Debbie Payne-Turner
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ashley Hill
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lei Shi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stanley Pounds
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chunxu Qu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Scott Newman
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Shalini C Reshmi
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Julie Gastier-Foster
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth A Raetz
- Division of Pediatric Hematology-Oncology, New York University, New York, NY, USA
| | - Michael J Borowitz
- Division of Hematologic Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Brent L Wood
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Kelly W Maloney
- University of Colorado School of Medicine and Children's Hospital, Aurora, CO, USA
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Orietta Spinelli
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jacob M Rowe
- Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Janis Racevskis
- Cancer Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yanming Zhang
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravi Bhatia
- Division of Hematology-Oncology, University of Birmingham, Birmingham, AL, USA
| | | | - Krzysztof Mrózek
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Clara D Bloomfield
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Wendy Stock
- University of Chicago Medical Center, Chicago, IL, USA
| | - Steven Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Williams E Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jun Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elisabeth Paietta
- Cancer Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - James R Downing
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mignon L Loh
- Department of Pediatrics, UCSF Benioff Children's Hospital and the Helen Diller Family, San Francisco, CA, USA
| | - Stephen P Hunger
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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24
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Ustun C, Morgan E, Moodie EEM, Pullarkat S, Yeung C, Broesby-Olsen S, Ohgami R, Kim Y, Sperr W, Vestergaard H, Chen D, Kluin PM, Dolan M, Mrózek K, Czuchlewski D, Horny HP, George TI, Kristensen TK, Ku NK, Yi CA, Møller MB, Marcucci G, Baughn L, Schiefer AI, Hilberink JR, Pullarkat V, Shanley R, Kohlschmidt J, Coulombe J, Salhotra A, Soma L, Cho C, Linden MA, Akin C, Gotlib J, Hoermann G, Hornick J, Nakamura R, Deeg J, Bloomfield CD, Weisdorf D, Litzow MR, Valent P, Huls G, Perales MA, Borthakur G. Core-binding factor acute myeloid leukemia with t(8;21): Risk factors and a novel scoring system (I-CBFit). Cancer Med 2018; 7:4447-4455. [PMID: 30117318 PMCID: PMC6144246 DOI: 10.1002/cam4.1733] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although the prognosis of core-binding factor (CBF) acute myeloid leukemia (AML) is better than other subtypes of AML, 30% of patients still relapse and may require allogeneic hematopoietic cell transplantation (alloHCT). However, there is no validated widely accepted scoring system to predict patient subsets with higher risk of relapse. METHODS Eleven centers in the US and Europe evaluated 247 patients with t(8;21)(q22;q22). RESULTS Complete remission (CR) rate was high (92.7%), yet relapse occurred in 27.1% of patients. A total of 24.7% of patients received alloHCT. The median disease-free (DFS) and overall (OS) survival were 20.8 and 31.2 months, respectively. Age, KIT D816V mutated (11.3%) or nontested (36.4%) compared with KIT D816V wild type (52.5%), high white blood cell counts (WBC), and pseudodiploidy compared with hyper- or hypodiploidy were included in a scoring system (named I-CBFit). DFS rate at 2 years was 76% for patients with a low-risk I-CBFit score compared with 36% for those with a high-risk I-CBFit score (P < 0.0001). Low- vs high-risk OS at 2 years was 89% vs 51% (P < 0.0001). CONCLUSIONS I-CBFit composed of readily available risk factors can be useful to tailor the therapy of patients, especially for whom alloHCT is not need in CR1 (ie, patients with a low-risk I-CBFit score).
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Affiliation(s)
- Celalettin Ustun
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth Morgan
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sheeja Pullarkat
- Department of Pathology, University of California, Los Angeles, California
| | - Cecilia Yeung
- Fred Hutchinson Cancer Research Center, Seattle, Washington.,University of Washington School of Medicine, Seattle, Washington
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense, Denmark.,Mastocytosis Center Odense University Hospital, Odense, Denmark
| | - Robert Ohgami
- Department of Pathology, Stanford University, Stanford, California
| | - Young Kim
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Wolfgang Sperr
- Division of Hematology & Hemostaseology, Ludwig Boltzmann Cluster Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hanne Vestergaard
- Mastocytosis Center Odense University Hospital, Odense, Denmark.,Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Dong Chen
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Philip M Kluin
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michelle Dolan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - David Czuchlewski
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Tracy I George
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico.,Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Thomas Kielsgaard Kristensen
- Mastocytosis Center Odense University Hospital, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Nam K Ku
- Department of Pathology, University of California, Los Angeles, California
| | - Cecilia Arana Yi
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Michael Boe Møller
- Mastocytosis Center Odense University Hospital, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Guido Marcucci
- Division of Hematology and HCT, City of Hope, Duarte, California
| | - Linda Baughn
- Department of Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - J R Hilberink
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vinod Pullarkat
- Division of Hematology and HCT, City of Hope, Duarte, California
| | - Ryan Shanley
- Biostatistics and Bioinformatics, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Janie Coulombe
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Lori Soma
- Fred Hutchinson Cancer Research Center, Seattle, Washington.,University of Washington School of Medicine, Seattle, Washington
| | - Christina Cho
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael A Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Cem Akin
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan
| | - Jason Gotlib
- Stanford Cancer Institute, School of Medicine, Stanford University, Stanford, California
| | - Gregor Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Jason Hornick
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ryo Nakamura
- Division of Hematology and HCT, City of Hope, Duarte, California
| | - Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, Washington.,University of Washington School of Medicine, Seattle, Washington
| | | | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mark R Litzow
- Department of Internal Medicine and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Peter Valent
- Division of Hematology & Hemostaseology, Ludwig Boltzmann Cluster Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gautam Borthakur
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, Texas
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25
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Bill M, Karunasiri M, Kohlschmidt J, Walker AE, Brannan Z, Volinia S, Bloomfield CD, Garzon R, Dorrance AM. Abstract 2455: The long non-coding RNA (lncRNA) DANCR in acute myeloid leukemia (AML) stem cells (LSC). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2455] [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
Introduction: Prognosis for AML patients (pts) is inadequate. Therapeutic strategies are needed to target not only bulk blasts but also the distinct LSCs, which are more resistant to chemotherapy & cause relapse. lncRNAs are non-coding RNA transcripts longer than 200 nucleotides that regulate cellular processes. A functional role in LSCs has yet to be elucidated.
Methods: We derived a LSC-specific lncRNA profile using whole transcriptome sequencing (RNA-seq) data of 377 pts (<60 years) with cytogenetically normal (CN) AML. These data were correlated with a 'core enriched' (CE) gene expression signature representing 44 genes deregulated in LSCs (Eppert, Nat.Med. 2011). DANCR expression in the LSC-enriched compartment was validated using qRT-PCR. Transferrin/antibody conjugated nanoparticle (NP) knock down (KD) was used as an efficient & less toxic avenue to deliver siRNA against DANCR or scramble (SCR) in vitro & in vivo. LSC features (self-renewal, quiescence, engraftment) were analyzed & frequency determined in 3 primary AML samples and a CN-AML (Flt3ITD/WT/MllPTD/WT) mouse model.
Results: 161 lncRNAs were consistently deregulated in CEhigh pts with a p<.001 & a correlation coefficient >.5 (Spearmen correlation test). We chose DANCR to further analyze because it was among the top lncRNAs upregulated in CEhigh pts, is highly conserved between human & mouse, & was previously shown to have a role in promoting stemness in hepatocellular carcinoma (Yuan, Hepatology 2016). We confirmed that DANCR expression was significantly higher in functionally validated LSC enriched populations (p=.05). To assess the role in self-renewal, we KD DANCR in pts cells & found a decrease in colony numbers after replating (average decrease vs SCR: 38.9%, p=.03). Using membrane labeling assays, we found a decrease of quiescent cells after DANCR KD (average decrease: 36.1%, p=.04). Long term colony-initiating cell cultures were performed to determine the LSC frequency & we found significant decreases in the number of LSCs in primary pts samples after DANCR KD (average decrease of LSC frequency: 79.2%, p=.001). Mice transplanted with murine AML cells (CD45.2+) were treated with NP (n=3 per group) for 5 days (d). 2d later, bone marrow was harvested & retransplantated (Tx) using limiting dilutions (2x106, 1x106, 5x105) into irradiated BoyJ (CD45.1+) recipients (n=30). 14d post-Tx, anti-Dancr recipient mice showed a lower engraftment (CD45.2/CD45.1: 37% vs 47%, p=.03) and also a concomitant improvement in survival (p<.001).
Conclusion: We show for the first time that LSCs have a distinct lncRNA profile. Among the highly expressed lncRNAs associated with LSCs we identified & validated DANCR. Our data show that DANCR has an impact on LSC function (self-renewal, quiescence, engraftment) & regulates LSC frequency. DANCR is the first lncRNA shown to have a functional role in LSCs & represents a novel target for AML treatment.
Citation Format: Marius Bill, Malith Karunasiri, Jessica Kohlschmidt, Allison E. Walker, Zachary Brannan, Stefano Volinia, Clara D. Bloomfield, Ramiro Garzon, Adrienne M. Dorrance. The long non-coding RNA (lncRNA) DANCR in acute myeloid leukemia (AML) stem cells (LSC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2455.
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26
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Eisfeld AK, Kohlschmidt J, Mrózek K, Blachly JS, Walker CJ, Nicolet D, Orwick S, Maharry SE, Carroll AJ, Stone RM, de la Chapelle A, Wang ES, Kolitz JE, Powell BL, Byrd JC, Bloomfield CD. Mutation patterns identify adult patients with de novo acute myeloid leukemia aged 60 years or older who respond favorably to standard chemotherapy: an analysis of Alliance studies. Leukemia 2018; 32:1338-1348. [PMID: 29563537 PMCID: PMC5992022 DOI: 10.1038/s41375-018-0068-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 11/09/2022]
Abstract
Thus far, only 5-15% of AML patients aged ≥60 years are cured with chemotherapy. Identification of patients who are less (more) likely to respond to standard chemotherapy might enable early risk stratification toward alternative treatment regimens. We used a next-generation sequencing panel of 80 cancer- and/or leukemia-associated genes to profile molecularly 423 older patients with de novo AML. Using variables identified in multivariable models and co-occurring mutations in NPM1-mutated AML, we classified the patients into good-, intermediate-, and poor-risk groups for complete remission (CR) attainment, disease-free (DFS), and overall survival (OS). Whereas 81% of good-risk patients (comprising NPM1-mutated patients harboring mutations in chromatin remodeling, cohesin complex, methylation-related, spliceosome, and/or RAS pathway genes, FLT3-TKD, and/or patients without FLT3-ITD) achieved a CR, only 32% of poor-risk patients (with U2AF1, WT1 mutations and/or complex karyotype) did. Intermediate-risk patients had a 50% CR rate. Similarly, using NPM1 co-mutation patterns and SF1 mutation status, we identified patients with favorable DFS and OS 3-year rates of 46% and 45%, respectively. Patients with adverse genetic features had DFS and OS rates of only 2% and 4%. We show that application of our proposed criteria may refine the 2017 European LeukemiaNet classification for older patients treated with chemotherapy.
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Affiliation(s)
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - James S Blachly
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Division of Hematology, Columbus, OH, USA
| | | | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance Statistics and Data Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Shelley Orwick
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Division of Hematology, Columbus, OH, USA
| | - Sophia E Maharry
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Bayard L Powell
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - John C Byrd
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Division of Hematology, Columbus, OH, USA
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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27
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Papaioannou D, Nicolet D, Volinia S, Mrózek K, Yan P, Bundschuh R, Carroll AJ, Kohlschmidt J, Blum W, Powell BL, Uy GL, Kolitz JE, Wang ES, Eisfeld AK, Orwick SJ, Lucas DM, Caligiuri MA, Stone RM, Byrd JC, Garzon R, Bloomfield CD. Prognostic and biologic significance of long non-coding RNA profiling in younger adults with cytogenetically normal acute myeloid leukemia. Haematologica 2017; 102:1391-1400. [PMID: 28473620 PMCID: PMC5541873 DOI: 10.3324/haematol.2017.166215] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
Long non-coding ribonucleic acids (RNAs) are a novel class of RNA molecules, which are increasingly recognized as important molecular players in solid and hematologic malignancies. Herein we investigated whether long non-coding RNA expression is associated with clinical and molecular features, as well as outcome of younger adults (aged <60 years) with de novo cytogenetically normal acute myeloid leukemia. Whole transcriptome profiling was performed in a training (n=263) and a validation set (n=114). Using the training set, we identified 24 long non-coding RNAs associated with event-free survival. Linear combination of the weighted expression values of these transcripts yielded a prognostic score. In the validation set, patients with high scores had shorter disease-free (P<0.001), overall (P=0.002) and event-free survival (P<0.001) than patients with low scores. In multivariable analyses, long non-coding RNA score status was an independent prognostic marker for disease-free (P=0.01) and event-free survival (P=0.002), and showed a trend for overall survival (P=0.06). Among multiple molecular alterations tested, which are prognostic in cytogenetically normal acute myeloid leukemia, only double CEBPA mutations, NPM1 mutations and FLT3-ITD associated with distinct long non-coding RNA signatures. Correlation of the long non-coding RNA scores with messenger RNA and microRNA expression identified enrichment of genes involved in lymphocyte/leukocyte activation, inflammation and apoptosis in patients with high scores. We conclude that long non-coding RNA profiling provides meaningful prognostic information in younger adults with cytogenetically normal acute myeloid leukemia. In addition, expression of prognostic long non-coding RNAs associates with oncogenic molecular pathways in this disease. clinicaltrials.gov Identifier: 00048958 (CALGB-8461), 00899223 (CALGB-9665), and 00900224 (CALGB-20202).
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Affiliation(s)
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Stefano Volinia
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Pearlly Yan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ralf Bundschuh
- Department of Physics, Department of Chemistry & Biochemistry, Division of Hematology, Department of Internal Medicine, Center for RNA Biology, The Ohio State University, Columbus, OH, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, AL, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - William Blum
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Bayard L Powell
- The Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Geoffrey L Uy
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan E Kolitz
- Hofstra North Shore-Long Island Jewish School of Medicine, Lake Success, NY, USA
| | | | | | - Shelley J Orwick
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David M Lucas
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Richard M Stone
- Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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28
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Zhang J, McCastlain K, Yoshihara H, Xu B, Chang Y, Churchman ML, Wu G, Li Y, Wei L, Iacobucci I, Liu Y, Qu C, Wen J, Edmonson M, Payne-Turner D, Kaufmann KB, Takayanagi SI, Wienholds E, Waanders E, Ntziachristos P, Bakogianni S, Wang J, Aifantis I, Roberts KG, Ma J, Song G, Easton J, Mulder HL, Chen X, Newman S, Ma X, Rusch M, Gupta P, Boggs K, Vadodaria B, Dalton J, Liu Y, Valentine ML, Ding L, Lu C, Fulton RS, Fulton L, Tabib Y, Ochoa K, Devidas M, Pei D, Cheng C, Yang J, Evans WE, Relling MV, Pui CH, Jeha S, Harvey RC, Chen IML, Willman CL, Marcucci G, Bloomfield CD, Kohlschmidt J, Mrózek K, Paietta E, Tallman MS, Stock W, Foster MC, Racevskis J, Rowe JM, Luger S, Kornblau SM, Shurtleff SA, Raimondi SC, Mardis ER, Wilson RK, Dick JE, Hunger SP, Loh ML, Downing JR, Mullighan CG. Deregulation of DUX4 and ERG in acute lymphoblastic leukemia. Nat Genet 2016; 48:1481-1489. [PMID: 27776115 PMCID: PMC5144107 DOI: 10.1038/ng.3691] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [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: 04/18/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022]
Abstract
Chromosomal rearrangements deregulating hematopoietic transcription factors are common in acute lymphoblastic leukemia (ALL). Here we show that deregulation of the homeobox transcription factor gene DUX4 and the ETS transcription factor gene ERG is a hallmark of a subtype of B-progenitor ALL that comprises up to 7% of B-ALL. DUX4 rearrangement and overexpression was present in all cases and was accompanied by transcriptional deregulation of ERG, expression of a novel ERG isoform, ERGalt, and frequent ERG deletion. ERGalt uses a non-canonical first exon whose transcription was initiated by DUX4 binding. ERGalt retains the DNA-binding and transactivation domains of ERG, but it inhibits wild-type ERG transcriptional activity and is transforming. These results illustrate a unique paradigm of transcription factor deregulation in leukemia in which DUX4 deregulation results in loss of function of ERG, either by deletion or induced expression of an isoform that is a dominant-negative inhibitor of wild-type ERG function.
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Affiliation(s)
- Jinghui Zhang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kelly McCastlain
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Hiroki Yoshihara
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Beisi Xu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yunchao Chang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Gang Wu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yongjin Li
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lei Wei
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yu Liu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Chunxu Qu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Ji Wen
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael Edmonson
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Kerstin B. Kaufmann
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Shin-ichiro Takayanagi
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
- Oncology Research Laboratories, Kyowa Hakko Kirin Co., Ltd., Machida-shi, Tokyo, 194-8533, Japan
| | - Erno Wienholds
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Esmé Waanders
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Human Genetics, Radboud University Medical Center and Radboud Center for Molecular Life Sciences, Nijmegen, the Netherlands
| | | | - Sofia Bakogianni
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Jingjing Wang
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Iannis Aifantis
- Department of Pathology, New York University School of Medicine, New York, NY
- Howard Hughes Medical Institute, New York, NY
| | - Kathryn G. Roberts
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jing Ma
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Guangchun Song
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - John Easton
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Heather L. Mulder
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Xiang Chen
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Scott Newman
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael Rusch
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Pankaj Gupta
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kristy Boggs
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Bhavin Vadodaria
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - James Dalton
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yanling Liu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Marcus L Valentine
- Cytogenetics Core Facility, St. Jude Children’s Research Hospital, Memphis, TN
| | - Li Ding
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Charles Lu
- McDonnell Genome Institute, Washington University, St Louis, MO
| | | | - Lucinda Fulton
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Yashodhan Tabib
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Kerri Ochoa
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine, Public Health & Health Profession, University of Florida, Gainesville, FL
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jun Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - William E. Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Richard C. Harvey
- Department of Pathology, The Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
| | - I-Ming L Chen
- Department of Pathology, The Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
| | - Cheryl L. Willman
- Department of Pathology, The Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
| | | | | | | | - Krzysztof Mrózek
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | | | | | - Wendy Stock
- University of Chicago Medical Center, Chicago, IL
| | - Matthew C. Foster
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC
| | - Janis Racevskis
- Department of Medicine (Oncology), Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | - Jacob M. Rowe
- Department of Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Selina Luger
- Department of Pediatrics, Benioff Children’s Hospital, University of California at San Francisco, San Francisco, CA
| | - Steven M. Kornblau
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Sheila A Shurtleff
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Susana C. Raimondi
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - John E. Dick
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Stephen P Hunger
- Department of Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mignon L. Loh
- Department of Pediatrics, Benioff Children’s Hospital, University of California at San Francisco, San Francisco, CA
| | - James R. Downing
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
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Roberts KG, Gu Z, Payne-Turner D, McCastlain K, Harvey RC, Chen IM, Pei D, Iacobucci I, Valentine M, Pounds SB, Shi L, Li Y, Zhang J, Cheng C, Rambaldi A, Tosi M, Spinelli O, Radich JP, Minden MD, Rowe JM, Luger S, Litzow MR, Tallman MS, Wiernik PH, Bhatia R, Aldoss I, Kohlschmidt J, Mrózek K, Marcucci G, Bloomfield CD, Stock W, Kornblau S, Kantarjian HM, Konopleva M, Paietta E, Willman CL, Mullighan CG. High Frequency and Poor Outcome of Philadelphia Chromosome-Like Acute Lymphoblastic Leukemia in Adults. J Clin Oncol 2016; 35:394-401. [PMID: 27870571 DOI: 10.1200/jco.2016.69.0073] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Philadelphia chromosome (Ph) -like acute lymphoblastic leukemia (ALL) is a high-risk subtype of childhood ALL characterized by kinase-activating alterations that are amenable to treatment with tyrosine kinase inhibitors. We sought to define the prevalence and genomic landscape of Ph-like ALL in adults and assess response to conventional chemotherapy. Patients and Methods The frequency of Ph-like ALL was assessed by gene expression profiling of 798 patients with B-cell ALL age 21 to 86 years. Event-free survival and overall survival were determined for Ph-like ALL versus non-Ph-like ALL patients. Detailed genomic analysis was performed on 180 of 194 patients with Ph-like ALL. Results Patients with Ph-like ALL accounted for more than 20% of adults with ALL, including 27.9% of young adults (age 21 to 39 years), 20.4% of adults (age 40 to 59 years), and 24.0% of older adults (age 60 to 86 years). Overall, patients with Ph-like ALL had an inferior 5-year event-free survival compared with patients with non-Ph-like ALL (22.5% [95% CI, 14.9% to 29.3%; n = 155] v 49.3% [95% CI, 42.8% to 56.2%; n = 247], respectively; P < .001). We identified kinase-activating alterations in 88% of patients with Ph-like ALL, including CRLF2 rearrangements (51%), ABL class fusions (9.8%), JAK2 or EPOR rearrangements (12.4%), other JAK-STAT sequence mutations (7.2%), other kinase alterations (4.1%), and Ras pathway mutations (3.6%). Eleven new kinase rearrangements were identified, including four involving new kinase or cytokine receptor genes and seven involving new partners for previously identified genes. Conclusion Ph-like ALL is a highly prevalent subtype of ALL in adults and is associated with poor outcome. The diverse range of kinase-activating alterations in Ph-like ALL has important therapeutic implications. Trials comparing the addition of tyrosine kinase inhibitors to conventional therapy are required to evaluate the clinical utility of these agents in the treatment of Ph-like ALL.
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Affiliation(s)
- Kathryn G Roberts
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhaohui Gu
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debbie Payne-Turner
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly McCastlain
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard C Harvey
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - I-Ming Chen
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deqing Pei
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ilaria Iacobucci
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcus Valentine
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stanley B Pounds
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Shi
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yongjin Li
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jinghui Zhang
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheng Cheng
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alessandro Rambaldi
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manuela Tosi
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Orietta Spinelli
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jerald P Radich
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark D Minden
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacob M Rowe
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Selina Luger
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark R Litzow
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Martin S Tallman
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter H Wiernik
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ravi Bhatia
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ibrahim Aldoss
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica Kohlschmidt
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Krzysztof Mrózek
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Guido Marcucci
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clara D Bloomfield
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendy Stock
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen Kornblau
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop M Kantarjian
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elisabeth Paietta
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheryl L Willman
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles G Mullighan
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
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Gu Z, Churchman M, Roberts K, Li Y, Liu Y, Harvey RC, McCastlain K, Reshmi SC, Payne-Turner D, Iacobucci I, Shao Y, Chen IM, Valentine M, Pei D, Mungall KL, Mungall AJ, Ma Y, Moore R, Marra M, Stonerock E, Gastier-Foster JM, Devidas M, Dai Y, Wood B, Borowitz M, Larsen EE, Maloney K, Mattano Jr LA, Angiolillo A, Salzer WL, Burke MJ, Gianni F, Spinelli O, Radich JP, Minden MD, Moorman AV, Patel B, Fielding AK, Rowe JM, Luger SM, Bhatia R, Aldoss I, Forman SJ, Kohlschmidt J, Mrózek K, Marcucci G, Bloomfield CD, Stock W, Kornblau S, Kantarjian HM, Konopleva M, Paietta E, Willman CL, L. Loh M, P. Hunger S, Mullighan CG. Genomic analyses identify recurrent MEF2D fusions in acute lymphoblastic leukaemia. Nat Commun 2016; 7:13331. [PMID: 27824051 PMCID: PMC5105166 DOI: 10.1038/ncomms13331] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [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: 02/07/2016] [Accepted: 09/23/2016] [Indexed: 12/29/2022] Open
Abstract
Chromosomal rearrangements are initiating events in acute lymphoblastic leukaemia (ALL). Here using RNA sequencing of 560 ALL cases, we identify rearrangements between MEF2D (myocyte enhancer factor 2D) and five genes (BCL9, CSF1R, DAZAP1, HNRNPUL1 and SS18) in 22 B progenitor ALL (B-ALL) cases with a distinct gene expression profile, the most common of which is MEF2D-BCL9. Examination of an extended cohort of 1,164 B-ALL cases identified 30 cases with MEF2D rearrangements, which include an additional fusion partner, FOXJ2; thus, MEF2D-rearranged cases comprise 5.3% of cases lacking recurring alterations. MEF2D-rearranged ALL is characterized by a distinct immunophenotype, DNA copy number alterations at the rearrangement sites, older diagnosis age and poor outcome. The rearrangements result in enhanced MEF2D transcriptional activity, lymphoid transformation, activation of HDAC9 expression and sensitive to histone deacetylase inhibitor treatment. Thus, MEF2D-rearranged ALL represents a distinct form of high-risk leukaemia, for which new therapeutic approaches should be considered.
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Affiliation(s)
- Zhaohui Gu
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
| | - Michelle Churchman
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
| | - Kathryn Roberts
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
| | - Yongjin Li
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Yu Liu
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Richard C. Harvey
- University of New Mexico Cancer Center, Albuquerque, New Mexico 87106, USA
| | - Kelly McCastlain
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
| | - Shalini C. Reshmi
- The Research Institute, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Debbie Payne-Turner
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
| | - Ilaria Iacobucci
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
| | - Ying Shao
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - I-Ming Chen
- University of New Mexico Cancer Center, Albuquerque, New Mexico 87106, USA
| | - Marcus Valentine
- Cytogenetic Shared Resource, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Deqing Pei
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee 38105
| | - Karen L. Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Andrew J. Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Richard Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Marco Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Eileen Stonerock
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
| | - Julie M. Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida 32611, USA
| | - Yunfeng Dai
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida 32611, USA
| | - Brent Wood
- Department of Laboratory Medicine, University of Washington, Seattle, Washington 98195, USA
| | - Michael Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
| | - Eric E. Larsen
- Maine Children's Cancer Program, Scarborough, Maine 04074, USA
| | - Kelly Maloney
- Pediatric Hematology/Oncology/BMT, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado 80045, USA
| | | | - Anne Angiolillo
- Children's National Medical Center, Washington, DC 20010, USA
| | - Wanda L. Salzer
- US Army Medical Research and Materiel Command, Fort Detrick, Maryland 21702, USA
| | | | - Francesca Gianni
- Department of Hematology and Bone Marrow Transplantation, Papa Giovanni XXIII Hospital Piazza OMS 1 24127, Bergamo, Italy
| | - Orietta Spinelli
- Department of Hematology and Bone Marrow Transplantation, Papa Giovanni XXIII Hospital Piazza OMS 1 24127, Bergamo, Italy
| | - Jerald P. Radich
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
| | - Mark D. Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Anthony V. Moorman
- Leukemia Research Cytogenetics Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Bella Patel
- Department of Haemato-Oncology, Barts Cancer Institute, London EC1M 6BQ, UK
| | | | - Jacob M. Rowe
- Hematology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Selina M. Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| | - Ibrahim Aldoss
- Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| | - Stephen J. Forman
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California 91010, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
- Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, California 91010, USA
| | - Clara D. Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA
| | - Wendy Stock
- University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Steven Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Hagop M. Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Elisabeth Paietta
- Cancer Center, Montefiore Medical Center North Division, Bronx, New York 10467, USA
| | - Cheryl L. Willman
- University of New Mexico Cancer Center, Albuquerque, New Mexico 87106, USA
| | - Mignon L. Loh
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, California 94158, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94115, USA
| | - Stephen P. Hunger
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Charles G. Mullighan
- Department of Pathology and Hematological Malignancies Program, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 342, Memphis, Tennessee 38105, USA
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Eisfeld AK, Kohlschmidt J, Mrózek K, Volinia S, Blachly JS, Nicolet D, Oakes C, Kroll K, Orwick S, Carroll AJ, Stone RM, Byrd JC, de la Chapelle A, Bloomfield CD. Mutational Landscape and Gene Expression Patterns in Adult Acute Myeloid Leukemias with Monosomy 7 as a Sole Abnormality. Cancer Res 2016; 77:207-218. [PMID: 27784745 DOI: 10.1158/0008-5472.can-16-1386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 12/31/2022]
Abstract
Monosomy of chromosome 7 is the most frequent autosomal monosomy in acute myeloid leukemia (AML), where it associates with poor clinical outcomes. However, molecular features associated with this sole monosomy subtype (-7 AML), which may give insights into the basis for its poor prognosis, have not been characterized. In this study, we analyzed 36 cases of -7 AML for mutations in 81 leukemia/cancer-associated genes using a customized targeted next-generation sequencing panel (Miseq). Global gene and miRNA expression profiles were also determined using paired RNA and small RNA sequencing data. Notably, gene mutations were detected in all the major AML-associated functional groups, which include activated signaling, chromatin remodeling, cohesin complex, methylation, NPM1, spliceosome, transcription factors, and tumor suppressors. Gene mutations in the chromatin remodeling groups were relatively more frequent in patients <60 years of age, who also had less mutations in the methylation and spliceosome groups compared with patients ≥60 years of age. Novel recurrent mutational events in AML were identified in the SMARCA2 gene. In patients ≥60 years of age, the presence of spliceosome mutations associated with a lower complete remission rate (P = 0.03). RNA sequencing revealed distinct gene and miRNA expression patterns between the sole -7 and non -7 AML cases, with reduced expression, as expected, of many genes and miRNAs mapped to chromosome 7, and overexpression of ID1, MECOM, and PTPRM, among others. Overall, our findings illuminate a number of molecular features of the underlying aggressive pathobiology in -7 AML patients. Cancer Res; 77(1); 207-18. ©2016 AACR.
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Affiliation(s)
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Stefano Volinia
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Christopher Oakes
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Karl Kroll
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Shelley Orwick
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | | | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Blum W, Sanford BL, Klisovic R, DeAngelo DJ, Uy G, Powell BL, Stock W, Baer MR, Kolitz JE, Wang ES, Hoke E, Mrózek K, Kohlschmidt J, Bloomfield CD, Geyer S, Marcucci G, Stone RM, Larson RA. Maintenance therapy with decitabine in younger adults with acute myeloid leukemia in first remission: a phase 2 Cancer and Leukemia Group B Study (CALGB 10503). Leukemia 2016; 31:34-39. [PMID: 27624549 PMCID: PMC5214595 DOI: 10.1038/leu.2016.252] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 04/08/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 12/12/2022]
Abstract
In this prospective phase 2 clinical trial conducted by Cancer and Leukemia Group B (CALGB, now the Alliance), we studied decitabine as maintenance therapy for younger adults with acute myeloid leukemia (AML) who remained in first complete remission (CR1) following intensive induction and consolidation. Given that decitabine is clinically active in AML and with hypomethylating activity distinct from cytotoxic chemotherapy, we hypothesized that one year of maintenance therapy would improve disease-free survival (DFS) for AML patients <60 years who did not receive allogeneic stem cell transplantation (alloHCT) in CR1. After blood count recovery from final consolidation, patients received decitabine at 20mg/m2 IV daily for 4–5 days, every 6 weeks for 8 cycles. One-hundred-thirty-four patients received decitabine, 85 (63%) had favorable risk AML. The median number of cycles received was 7 (range, 1–8), and the primary reason for discontinuation was relapse. DFS at 1-year and 3-years was 79% and 54%, respectively. These results are similar to the outcomes in the historical control comprised of similar patients treated on recent CALGB trials. Thus, maintenance with decitabine provided no benefit overall. Standard use of decitabine maintenance in younger AML patients in CR1 is not warranted. This trial was registered at www.clinicaltrials.gov as NCT00416598.
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Affiliation(s)
- W Blum
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - B L Sanford
- The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - R Klisovic
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - D J DeAngelo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - G Uy
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - B L Powell
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - W Stock
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M R Baer
- Department of Medicine and Greenebaum Cancer Center University of Maryland, Baltimore, MD, USA
| | - J E Kolitz
- Hofstra North Shore-Long Island Jewish School of Medicine, Manhasset, NY, USA
| | - E S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - E Hoke
- The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - K Mrózek
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - J Kohlschmidt
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,The Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - C D Bloomfield
- Division of Hematology and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - S Geyer
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - G Marcucci
- Gehr Family Leukemia Center, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - R M Stone
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - R A Larson
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Bhatnagar B, Eisfeld AK, Nicolet D, Mrózek K, Blachly JS, Orwick S, Lucas DM, Kohlschmidt J, Blum W, Kolitz JE, Stone RM, Bloomfield CD, Byrd JC. Persistence of DNMT3A R882 mutations during remission does not adversely affect outcomes of patients with acute myeloid leukaemia. Br J Haematol 2016; 175:226-236. [PMID: 27476855 DOI: 10.1111/bjh.14254] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/07/2016] [Indexed: 12/30/2022]
Abstract
Somatic mutation of the DNMT3A gene at the arginine R882 site is common in acute myeloid leukaemia (AML). The prognostic significance of DNMT3A R882 mutation clearance, using traditional diagnostic next generation sequencing (NGS) methods, during complete remission (CR) in AML patients is controversial. We examined the impact of clearing DNMT3A R882 mutations at diagnosis to the detectable threshold of ˂3% during CR on outcome in 56 adult AML patients. Mutational remission, defined as clearance of pre-treatment DNMT3A R882 and all other AML-associated mutations to a variant allele frequency ˂3%, occurred in 14 patients whereas persistent DNMT3A R882 mutations were observed in 42 patients. There were no significant differences in disease-free or overall survival between patients with and without DNMT3A R882 mutation clearance. Patients with persistent DNMT3A R882 who cleared all other AML mutations and did not acquire new mutations (n = 30), trended towards longer disease-free survival (1·6 vs. 0·6 years, P = 0·06) than patients with persistence of DNMT3A R882, in addition to other mutations or acquisition of new AML-associated mutations, such as those in TET2, JAK2, ASXL1 and TP53 (n = 12). These data demonstrate that DNMT3A R882 mutations, as assessed by traditional NGS methods, persist in the majority of AML patients in CR.
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Affiliation(s)
- Bhavana Bhatnagar
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. .,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | | | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Shelley Orwick
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David M Lucas
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - William Blum
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra North Shore-Long Island Jewish School of Medicine, Lake Success, NY, USA
| | | | - Clara D Bloomfield
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. .,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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Niederwieser C, Nicolet D, Carroll AJ, Kolitz JE, Powell BL, Kohlschmidt J, Stone RM, Byrd JC, Mrózek K, Bloomfield CD. Chromosome abnormalities at onset of complete remission are associated with worse outcome in patients with acute myeloid leukemia and an abnormal karyotype at diagnosis: CALGB 8461 (Alliance). Haematologica 2016; 101:1516-1523. [PMID: 27470602 DOI: 10.3324/haematol.2016.149542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
Achievement of complete remission is essential for long-term survival of acute myeloid leukemia patients. We evaluated the prognostic significance of cytogenetics at complete remission in 258 adults with de novo acute myeloid leukemia and abnormal pre-treatment karyotypes, treated on Cancer and Leukemia Group B front-line studies, with cytogenetic data at onset of morphological complete remission. Thirty-two patients had abnormal karyotypes at time of initial complete remission. Of these, 28 had at least 1 abnormality identified pre-treatment, and 4 acute myeloid leukemia-related abnormalities not detected pre-treatment. Two hundred and twenty-six patients had normal remission karyotypes. Patients with abnormal remission karyotypes were older (P<0.001), had lower pre-treatment white blood counts (P=0.002) and blood blast percentages (P=0.004), were less often classified as Favorable and more often as Adverse among European LeukemiaNet Genetic Groups (P<0.001), and had shorter disease-free survival (median 0.6 vs. 0.9 years; P<0.001) and overall survival (median 1.2 vs. 2.2 years; P<0.001) than patients with normal remission karyotypes. Sixteen patients with normal remission karyotypes also harbored non-clonal abnormalities unrelated to pre-treatment karyotypes. They had shorter overall survival than 210 patients with only normal metaphases (P=0.04). Forty-eight patients with any clonal or non-clonal chromosome abnormality at complete remission had worse disease-free survival (median 0.6 vs. 1.0 years; P<0.001) and overall survival (median 1.2 vs. 2.5 years; P<0.001) than 210 patients with exclusively normal metaphases. In multivariable analyses, after adjustment for age, the presence of any remission abnormality was associated with shorter disease-free survival (P=0.03) and overall survival (P=0.01). We conclude that detection of any abnormality at complete remission is an adverse prognostic factor. (clinicaltrials.gov identifier: 00048958).
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Affiliation(s)
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra North Shore-Long Island Jewish School of Medicine, Lake Success, NY, USA
| | - Bayard L Powell
- Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Clara D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Eisfeld AK, Kohlschmidt J, Mrózek K, Blachly JS, Nicolet D, Kroll K, Orwick S, Carroll AJ, Stone RM, de la Chapelle A, Byrd JC, Bloomfield CD. Adult acute myeloid leukemia with trisomy 11 as the sole abnormality is characterized by the presence of five distinct gene mutations: MLL-PTD, DNMT3A, U2AF1, FLT3-ITD and IDH2. Leukemia 2016; 30:2254-2258. [PMID: 27435003 DOI: 10.1038/leu.2016.196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A-K Eisfeld
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - K Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - D Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - K Kroll
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - S Orwick
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - A J Carroll
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - R M Stone
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - A de la Chapelle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - C D Bloomfield
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Sood R, Hansen NF, Donovan FX, Carrington B, Bucci D, Maskeri B, Young A, Trivedi NS, Kohlschmidt J, Stone RM, Caligiuri MA, Chandrasekharappa SC, Marcucci G, Mullikin JC, Bloomfield CD, Liu P. Somatic mutational landscape of AML with inv(16) or t(8;21) identifies patterns of clonal evolution in relapse leukemia. Leukemia 2015; 30:501-4. [PMID: 26139325 PMCID: PMC4679720 DOI: 10.1038/leu.2015.141] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Sood
- Oncogenesis and Development Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Zebrafish Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - N F Hansen
- Comparative Genomics Analysis Unit, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - F X Donovan
- Genomics Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Carrington
- Zebrafish Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - D Bucci
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - B Maskeri
- NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Young
- NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - N S Trivedi
- Bioinformatics and Scientific Programming Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Kohlschmidt
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - R M Stone
- Medical Oncology/Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - M A Caligiuri
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - S C Chandrasekharappa
- Genomics Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Genomics Unit, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - G Marcucci
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.,Department of Hematology and Hematopoietic Cell Transplantation, Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope, Duarte, CA, USA
| | - J C Mullikin
- Comparative Genomics Analysis Unit, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - C D Bloomfield
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - P Liu
- Oncogenesis and Development Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Niederwieser C, Kohlschmidt J, Volinia S, Whitman SP, Metzeler KH, Eisfeld AK, Maharry K, Yan P, Frankhouser D, Becker H, Schwind S, Carroll AJ, Nicolet D, Mendler JH, Curfman JP, Wu YZ, Baer MR, Powell BL, Kolitz JE, Moore JO, Carter TH, Bundschuh R, Larson RA, Stone RM, Mrózek K, Marcucci G, Bloomfield CD. Prognostic and biologic significance of DNMT3B expression in older patients with cytogenetically normal primary acute myeloid leukemia. Leukemia 2015; 29:567-75. [PMID: 25204569 PMCID: PMC4351165 DOI: 10.1038/leu.2014.267] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 05/13/2014] [Revised: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023]
Abstract
DNMT3B encodes a DNA methyltransferase implicated in aberrant epigenetic changes contributing to leukemogenesis. We tested whether DNMT3B expression, measured by NanoString nCounter assay, associates with outcome, gene and microRNA expression and DNA methylation profiles in 210 older (⩾60 years) adults with primary, cytogenetically normal acute myeloid leukemia (CN-AML). Patients were dichotomized into high versus low expressers using median cut. Outcomes were assessed in the context of known CN-AML prognosticators. Gene and microRNA expression, and DNA methylation profiles were analyzed using microarrays and MethylCap-sequencing, respectively. High DNMT3B expressers had fewer complete remissions (CR; P=0.002) and shorter disease-free (DFS; P=0.02) and overall (OS; P<0.001) survival. In multivariable analyses, high DNMT3B expression remained an independent predictor of lower CR rates (P=0.04) and shorter DFS (P=0.04) and OS (P=0.001). High DNMT3B expression associated with a gene expression profile comprising 363 genes involved in differentiation, proliferation and survival pathways, but with only four differentially expressed microRNAs (miR-133b, miR-148a, miR-122, miR-409-3p) and no differential DNA methylation regions. We conclude that high DNMT3B expression independently associates with adverse outcome in older CN-AML patients. Gene expression analyses suggest that DNMT3B is involved in the modulation of several genes, although the regulatory mechanisms remain to be investigated to devise therapeutic approaches specific for these patients.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Cytarabine/therapeutic use
- DNA (Cytosine-5-)-Methyltransferases/genetics
- DNA Methylation
- Daunorubicin/therapeutic use
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Leukemic
- Humans
- Induction Chemotherapy
- Karyotyping
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Male
- MicroRNAs/genetics
- Microarray Analysis
- Middle Aged
- Prognosis
- Survival Analysis
- DNA Methyltransferase 3B
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Affiliation(s)
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Stefano Volinia
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Susan P. Whitman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Kati Maharry
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Pearlly Yan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Heiko Becker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Jason H. Mendler
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - John P. Curfman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yue-Zhong Wu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Maria R. Baer
- Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Bayard L. Powell
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Jonathan E. Kolitz
- Monter Cancer Center, Hofstra North Shore-Long Island Jewish School of Medicine, Lake Success, NY
| | | | | | - Ralf Bundschuh
- Departments of Physics and Chemistry & Biochemistry, The Ohio State University, Columbus, OH
| | | | | | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Guido Marcucci
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Roberts KG, Li Y, Payne-Turner D, Harvey RC, Yang YL, Pei D, McCastlain K, Ding L, Lu C, Song G, Ma J, Becksfort J, Rusch M, Chen SC, Easton J, Cheng J, Boggs K, Santiago-Morales N, Iacobucci I, Fulton RS, Wen J, Valentine M, Cheng C, Paugh SW, Devidas M, Chen IM, Reshmi S, Smith A, Hedlund E, Gupta P, Nagahawatte P, Wu G, Chen X, Yergeau D, Vadodaria B, Mulder H, Winick NJ, Larsen EC, Carroll WL, Heerema NA, Carroll AJ, Grayson G, Tasian SK, Moore AS, Keller F, Frei-Jones M, Whitlock JA, Raetz EA, White DL, Hughes TP, Guidry Auvil JM, Smith MA, Marcucci G, Bloomfield CD, Mrózek K, Kohlschmidt J, Stock W, Kornblau SM, Konopleva M, Paietta E, Pui CH, Jeha S, Relling MV, Evans WE, Gerhard DS, Gastier-Foster JM, Mardis E, Wilson RK, Loh ML, Downing JR, Hunger SP, Willman CL, Zhang J, Mullighan CG. Targetable kinase-activating lesions in Ph-like acute lymphoblastic leukemia. N Engl J Med 2014; 371:1005-15. [PMID: 25207766 PMCID: PMC4191900 DOI: 10.1056/nejmoa1403088] [Citation(s) in RCA: 965] [Impact Index Per Article: 96.5] [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: 01/05/2023]
Abstract
BACKGROUND Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) is characterized by a gene-expression profile similar to that of BCR-ABL1-positive ALL, alterations of lymphoid transcription factor genes, and a poor outcome. The frequency and spectrum of genetic alterations in Ph-like ALL and its responsiveness to tyrosine kinase inhibition are undefined, especially in adolescents and adults. METHODS We performed genomic profiling of 1725 patients with precursor B-cell ALL and detailed genomic analysis of 154 patients with Ph-like ALL. We examined the functional effects of fusion proteins and the efficacy of tyrosine kinase inhibitors in mouse pre-B cells and xenografts of human Ph-like ALL. RESULTS Ph-like ALL increased in frequency from 10% among children with standard-risk ALL to 27% among young adults with ALL and was associated with a poor outcome. Kinase-activating alterations were identified in 91% of patients with Ph-like ALL; rearrangements involving ABL1, ABL2, CRLF2, CSF1R, EPOR, JAK2, NTRK3, PDGFRB, PTK2B, TSLP, or TYK2 and sequence mutations involving FLT3, IL7R, or SH2B3 were most common. Expression of ABL1, ABL2, CSF1R, JAK2, and PDGFRB fusions resulted in cytokine-independent proliferation and activation of phosphorylated STAT5. Cell lines and human leukemic cells expressing ABL1, ABL2, CSF1R, and PDGFRB fusions were sensitive in vitro to dasatinib, EPOR and JAK2 rearrangements were sensitive to ruxolitinib, and the ETV6-NTRK3 fusion was sensitive to crizotinib. CONCLUSIONS Ph-like ALL was found to be characterized by a range of genomic alterations that activate a limited number of signaling pathways, all of which may be amenable to inhibition with approved tyrosine kinase inhibitors. Trials identifying Ph-like ALL are needed to assess whether adding tyrosine kinase inhibitors to current therapy will improve the survival of patients with this type of leukemia. (Funded by the American Lebanese Syrian Associated Charities and others.).
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Affiliation(s)
- Kathryn G Roberts
- From the Departments of Pathology (K.G.R., D.P.-T., Y.-L.Y., K. McCastlain, G.S., J.M., S.-C.C., J.C., N.S.-M., I.I., J.W., J.R.D., C.G.M.), Computational Biology and Bioinformatics (Y.L., J.B., M.R., E.H., P.G., P.N., G.W., X.C., J.Z.), Biostatistics (D.P., C.C.), Pharmaceutical Sciences (S.W.P., M.V.R., W.E.E.), and Oncology (C.-H.P., S.J.), the Pediatric Cancer Genome Project (Y.L., L.D., C.L., M.R., J.E., J.C., K.B., R.S.F., E.H., P.G., P.N., G.W., X.C., D.Y., B.V., H.M., M.V.R., W.E.E., E.M., R.K.W., J.R.D., J.Z., C.G.M.), and Cytogenetics Shared Resource (M.V.), St. Jude Children's Research Hospital, Memphis, TN; the University of New Mexico Cancer Center and School of Medicine, Albuquerque (R.C.H., I-M.C., C.L.W.); the Genome Institute at Washington University (L.D., C.L., R.S.F., E.M., R.K.W.), the Department of Genetics, Washington University School of Medicine (L.D., C.L., R.S.F., E.M., R.K.W.), and Siteman Cancer Center, Washington University (E.M., R.K.W.) - all in St. Louis; Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville (M.D.); the Research Institute at Nationwide Children's Hospital (S.R., A.S., J.M.G.-F.), the Department of Pathology, College of Medicine, Ohio State University (N.A.H.), and Ohio State University Comprehensive Cancer Center (G.M., C.D.B., K. Mrózek, J.K.) - all in Columbus, OH; the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (N.J.W.), Scott and White Hospitals and Clinics and Texas A&M Health Science Center, Temple (G.G.), the University of Texas Health Science Center San Antonio, San Antonio (M.F.-J.), and the Departments of Leukemia and Stem Cell Transplantation, Division of Cancer Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.M.K., M.K.) - all in Texas; Maine Children's Cancer Program, Scarborough (E.C.L.); New York University Cancer Institute, New York (W.L.C.), and the Department of Medicine (Oncology), Albert Einstein
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Alachkar H, Santhanam R, Maharry K, Metzeler KH, Huang X, Kohlschmidt J, Mendler JH, Benito JM, Hickey C, Neviani P, Dorrance AM, Anghelina M, Khalife J, Tarighat SS, Volinia S, Whitman SP, Paschka P, Hoellerbauer P, Wu YZ, Han L, Bolon BN, Blum W, Mrózek K, Carroll AJ, Perrotti D, Andreeff M, Caligiuri MA, Konopleva M, Garzon R, Bloomfield CD, Marcucci G. SPARC promotes leukemic cell growth and predicts acute myeloid leukemia outcome. J Clin Invest 2014; 124:1512-24. [PMID: 24590286 DOI: 10.1172/jci70921] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 01/02/2014] [Indexed: 12/20/2022] Open
Abstract
Aberrant expression of the secreted protein, acidic, cysteine-rich (osteonectin) (SPARC) gene, which encodes a matricellular protein that participates in normal tissue remodeling, is associated with a variety of diseases including cancer, but the contribution of SPARC to malignant growth remains controversial. We previously reported that SPARC was among the most upregulated genes in cytogenetically normal acute myeloid leukemia (CN-AML) patients with gene-expression profiles predictive of unfavorable outcome, such as mutations in isocitrate dehydrogenase 2 (IDH2-R172) and overexpression of the oncogenes brain and acute leukemia, cytoplasmic (BAALC) and v-ets erythroblastosis virus E26 oncogene homolog (ERG). In contrast, SPARC was downregulated in CN-AML patients harboring mutations in nucleophosmin (NPM1) that are associated with favorable prognosis. Based on these observations, we hypothesized that SPARC expression is clinically relevant in AML. Here, we found that SPARC overexpression is associated with adverse outcome in CN-AML patients and promotes aggressive leukemia growth in murine models of AML. In leukemia cells, SPARC expression was mediated by the SP1/NF-κB transactivation complex. Furthermore, secreted SPARC activated the integrin-linked kinase/AKT (ILK/AKT) pathway, likely via integrin interaction, and subsequent β-catenin signaling, which is involved in leukemia cell self-renewal. Pharmacologic inhibition of the SP1/NF-κB complex resulted in SPARC downregulation and leukemia growth inhibition. Together, our data indicate that evaluation of SPARC expression has prognosticative value and SPARC is a potential therapeutic target for AML.
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Marcucci G, Yan P, Maharry K, Frankhouser D, Nicolet D, Metzeler KH, Kohlschmidt J, Mrózek K, Wu YZ, Bucci D, Curfman JP, Whitman SP, Eisfeld AK, Mendler JH, Schwind S, Becker H, Bär C, Carroll AJ, Baer MR, Wetzler M, Carter TH, Powell BL, Kolitz JE, Byrd JC, Plass C, Garzon R, Caligiuri MA, Stone RM, Volinia S, Bundschuh R, Bloomfield CD. Epigenetics meets genetics in acute myeloid leukemia: clinical impact of a novel seven-gene score. J Clin Oncol 2013; 32:548-56. [PMID: 24378410 DOI: 10.1200/jco.2013.50.6337] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Molecular risk stratification of acute myeloid leukemia (AML) is largely based on genetic markers. However, epigenetic changes, including DNA methylation, deregulate gene expression and may also have prognostic impact. We evaluated the clinical relevance of integrating DNA methylation and genetic information in AML. METHODS Next-generation sequencing analysis of methylated DNA identified differentially methylated regions (DMRs) associated with prognostic mutations in older (≥ 60 years) cytogenetically normal (CN) patients with AML (n = 134). Genes with promoter DMRs and expression levels significantly associated with outcome were used to compute a prognostic gene expression weighted summary score that was tested and validated in four independent patient sets (n = 355). RESULTS In the training set, we identified seven genes (CD34, RHOC, SCRN1, F2RL1, FAM92A1, MIR155HG, and VWA8) with promoter DMRs and expression associated with overall survival (OS; P ≤ .001). Each gene had high DMR methylation and lower expression, which were associated with better outcome. A weighted summary expression score of the seven gene expression levels was computed. A low score was associated with a higher complete remission (CR) rate and longer disease-free survival and OS (P < .001 for all end points). This was validated in multivariable models and in two younger (< 60 years) and two older independent sets of patients with CN-AML. Considering the seven genes individually, the fewer the genes with high expression, the better the outcome. Younger and older patients with no genes or one gene with high expression had the best outcomes (CR rate, 94% and 87%, respectively; 3-year OS, 80% and 42%, respectively). CONCLUSION A seven-gene score encompassing epigenetic and genetic prognostic information identifies novel AML subsets that are meaningful for treatment guidance.
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Affiliation(s)
- Guido Marcucci
- Guido Marcucci, Pearlly Yan, Kati Maharry, David Frankhouser, Deedra Nicolet, Klaus H. Metzeler, Jessica Kohlschmidt, Krzysztof Mrózek, Yue-Zhong Wu, Donna Bucci, John P. Curfman, Susan P. Whitman, Ann-Kathrin Eisfeld, Jason H. Mendler, Sebastian Schwind, Heiko Becker, John C. Byrd, Ramiro Garzon, Michael A. Caligiuri, Stefano Volinia, and Clara D. Bloomfield, The Ohio State University Comprehensive Cancer Center; Ralf Bundschuh, The Ohio State University, Columbus, OH; Kati Maharry, Deedra Nicolet, and Jessica Kohlschmidt, Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN; Andrew J. Carroll, University of Alabama at Birmingham, Birmingham, AL; Maria R. Baer, Greenebaum Cancer Center, University of Maryland, Baltimore, MD; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Jonathan E. Kolitz, Monter Cancer Center, Lake Success, NY; Thomas H. Carter, University of Iowa, Iowa City, IA; Bayard L. Powell, The Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC; Richard M. Stone, Dana-Farber Cancer Institute, Boston, MA; Constance Bär and Christoph Plass, German Cancer Research Center, Heidelberg, Germany
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Wetzler M, Mrózek K, Kohlschmidt J, Dombret H, Döhner H, Pilorge S, Krug U, Carroll AJ, Larson RA, Marcucci G, Hiddemann W, Büchner T, Bloomfield CD. Intensive induction is effective in selected octogenarian acute myeloid leukemia patients: prognostic significance of karyotype and selected molecular markers used in the European LeukemiaNet classification. Haematologica 2013; 99:308-13. [PMID: 24097631 DOI: 10.3324/haematol.2013.092072] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We investigated whether octogenarian patients with acute myeloid leukemia enrolled onto Cooperative Group clinical trials and treated with intensive induction therapy could be cured, and whether karyotype and selected molecular markers had any prognostic significance in these patients. Among 138 patients with cytogenetic information, normal karyotype was the most common (47.1%) followed by complex karyotype (14.5%) and sole +8 (9.4%). Among these patients, the relapse-free survival rate at 1 year was 37% and 13% at 3 years, and the respective overall survival rates were 24% and 8%. Whereas the 90 patients who survived beyond 30 days had the same relapse-free survival rates, their 1-year and 3-year overall survival rates were 36% and 11%, respectively. Of the 66 patients surviving beyond 30 days who could be classified into European LeukemiaNet genetic groups, those in the intermediate-I group had better overall survival than patients in the adverse group (P=0.01). Among patients with cytogenetically normal acute myeloid leukemia who were tested for the European LeukemiaNet-associated molecular alterations, FLT3-internal tandem duplication and NPM1 mutations, it was found that FLT3-internal tandem duplication (detected in 29% of patients) did not associate with overall survival (P=0.31), whereas NPM1 mutations (30%) were associated with a significantly longer overall survival (P=0.002). We conclude that intensive induction is effective and indicated in selected octogenarians with acute myeloid leukemia, that their overall survival varies among the European LeukemiaNet genetic groups and that NPM1 mutations may be of prognostic significance among octogenarian patients with cytogenetically normal acute myeloid leukemia.
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Metzeler KH, Maharry K, Kohlschmidt J, Volinia S, Mrózek K, Becker H, Nicolet D, Whitman SP, Mendler JH, Schwind S, Eisfeld AK, Wu YZ, Powell BL, Carter TH, Wetzler M, Kolitz JE, Baer MR, Carroll AJ, Stone RM, Caligiuri MA, Marcucci G, Bloomfield CD. A stem cell-like gene expression signature associates with inferior outcomes and a distinct microRNA expression profile in adults with primary cytogenetically normal acute myeloid leukemia. Leukemia 2013; 27:2023-31. [PMID: 23765227 DOI: 10.1038/leu.2013.181] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/29/2013] [Accepted: 06/07/2013] [Indexed: 12/18/2022]
Abstract
Acute myeloid leukemia (AML) is hypothesized to be sustained by self-renewing leukemia stem cells (LSCs). Recently, gene expression signatures (GES) from functionally defined AML LSC populations were reported, and expression of a 'core enriched' (CE) GES, representing 44 genes activated in LCSs, conferred shorter survival in cytogenetically normal (CN) AML. The prognostic impact of the CE GES in the context of other molecular markers, including gene mutations and microRNA (miR) expression alterations, is unknown and its clinical utility is unclear. We studied associations of the CE GES with known molecular prognosticators, miR expression profiles, and outcomes in 364 well-characterized CN-AML patients. A high CE score (CE(high)) associated with FLT3-internal tandem duplication, WT1 and RUNX1 mutations, wild-type CEBPA and TET2, and high ERG, BAALC and miR-155 expression. CE(high) patients had a lower complete remission (CR) rate (P=0.003) and shorter disease-free (DFS, P<0.001) and overall survival (OS, P<0.001) than CE(low) patients. These associations persisted in multivariable analyses adjusting for other prognosticators (CR, P=0.02; DFS, P<0.001; and OS, P<0.001). CE(high) status was accompanied by a characteristic miR expression signature. Fifteen miRs were upregulated in both younger and older CE(high) patients, including miRs relevant for stem cell function. Our results support the clinical relevance of LSCs and improve risk stratification in AML.
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Affiliation(s)
- K H Metzeler
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Mendler JH, Maharry K, Becker H, Eisfeld AK, Senter L, Mrózek K, Kohlschmidt J, Metzeler KH, Schwind S, Whitman SP, Khalife J, Caligiuri MA, Klisovic RB, Moore JO, Carter TH, Marcucci G, Bloomfield CD. In rare acute myeloid leukemia patients harboring both RUNX1 and NPM1 mutations, RUNX1 mutations are unusual in structure and present in the germline. Haematologica 2013; 98:e92-4. [PMID: 23753029 DOI: 10.3324/haematol.2013.089904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Marcucci G, Maharry KS, Metzeler KH, Volinia S, Wu YZ, Mrózek K, Nicolet D, Kohlschmidt J, Whitman SP, Mendler JH, Schwind S, Becker H, Eisfeld AK, Carroll AJ, Powell BL, Kolitz JE, Garzon R, Caligiuri MA, Stone RM, Bloomfield CD. Clinical role of microRNAs in cytogenetically normal acute myeloid leukemia: miR-155 upregulation independently identifies high-risk patients. J Clin Oncol 2013; 31:2086-93. [PMID: 23650424 DOI: 10.1200/jco.2012.45.6228] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the impact of miR-155 on the outcome of adults with cytogenetically normal (CN) acute myeloid leukemia (AML) in the context of other clinical and molecular prognosticators and to gain insight into the leukemogenic role of this microRNA. PATIENTS AND METHODS We evaluated 363 patients with primary CN-AML. miR-155 levels were measured in pretreatment marrow and blood by NanoString nCounter assays that quantified the expression of the encoding gene MIR155HG. All molecular prognosticators were assessed centrally. miR-155-associated gene and microRNA expression profiles were derived using microarrays. RESULTS Considering all patients, high miR-155 expression was associated with a lower complete remission (CR) rate (P < .001) and shorter disease-free survival (P = .001) and overall survival (OS; P < .001) after adjusting for age. In multivariable analyses, high miR-155 expression remained an independent predictor for a lower CR rate (P = .007) and shorter OS (P < .001). High miR-155 expressers had approximately 50% reduction in the odds of achieving CR and 60% increase in the risk of death compared with low miR-155 expressers. Although high miR-155 expression was not associated with a distinct microRNA expression profile, it was associated with a gene expression profile enriched for genes involved in cellular mechanisms deregulated in AML (eg, apoptosis, nuclear factor-κB activation, and inflammation), thereby supporting a pivotal and unique role of this microRNA in myeloid leukemogenesis. CONCLUSION miR-155 expression levels are associated with clinical outcome independently of other strong clinical and molecular predictors. The availability of emerging compounds with antagonistic activity to microRNAs in the clinic provides the opportunity for future therapeutic targeting of miR-155 in AML.
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Affiliation(s)
- Guido Marcucci
- The Ohio State University, Comprehensive Cancer Center, Biomedical Research Tower 460 W. 12th Ave, Columbus, OH 43210, USA.
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Walker A, Mrózek K, Kohlschmidt J, Rao KW, Pettenati MJ, Sterling LJ, Marcucci G, Carroll AJ, Bloomfield CD. New recurrent balanced translocations in acute myeloid leukemia and myelodysplastic syndromes: cancer and leukemia group B 8461. Genes Chromosomes Cancer 2013; 52:385-401. [PMID: 23225546 PMCID: PMC3874732 DOI: 10.1002/gcc.22036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Received: 10/25/2012] [Accepted: 10/31/2012] [Indexed: 12/16/2022] Open
Abstract
Acquired chromosome abnormalities in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) are among the most valuable determinants of diagnosis and prognosis. In search of new recurrent balanced translocations, we reviewed the Cancer and Leukemia Group B (CALGB) cytogenetics database containing pretreatment and relapse karyotypes of 4,701 adults with AML and 565 with MDS who were treated on CALGB trials. We identified all cases with balanced structural rearrangements occurring as a sole abnormality or in addition to one other abnormality, excluded abnormalities known to be recurrent, and then reviewed the literature to determine whether any of what we considered unique, previously unknown abnormalities had been reported. As a result, we identified seven new recurrent balanced translocations in AML or MDS: t(7;11)(q22;p15.5), t(10;11)(q23;p15), t(2;12)(p13;p13), t(12;17)(p13;q12), t(2;3)(p21;p21), t(5;21)(q31;q22), and t(8;14)(q24.1;q32.2), and additionally, t(10;12)(p11;q15), a new translocation in AML previously reported in a case of acute lymphoblastic leukemia. Herein, we report hematologic and clinical characteristics and treatment outcomes of patients with these newly recognized recurrent translocations. We also report 52 unique balanced translocations, together with the clinical data of patients harboring them, which to our knowledge have not been previously published. We hope that once the awareness of their existence is increased, some of these translocations may become recognized as novel recurring abnormalities. Identification of additional cases with both the new recurrent and the unique balanced translocations will enable determination of their prognostic significance and help to provide insights into the mechanisms of disease pathogenesis in patients with these rare abnormalities.
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Affiliation(s)
- Alison Walker
- Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Krzysztof Mrózek
- Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Jessica Kohlschmidt
- Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Kathleen W. Rao
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark J. Pettenati
- Comprehensive Cancer Center Wake Forest University, Winston-Salem, NC
| | - Lisa J. Sterling
- Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Guido Marcucci
- Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | | | - Clara D. Bloomfield
- Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
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Mrózek K, Marcucci G, Nicolet D, Maharry KS, Becker H, Whitman SP, Metzeler KH, Schwind S, Wu YZ, Kohlschmidt J, Pettenati MJ, Heerema NA, Block AW, Patil SR, Baer MR, Kolitz JE, Moore JO, Carroll AJ, Stone RM, Larson RA, Bloomfield CD. Prognostic significance of the European LeukemiaNet standardized system for reporting cytogenetic and molecular alterations in adults with acute myeloid leukemia. J Clin Oncol 2012; 30:4515-23. [PMID: 22987078 DOI: 10.1200/jco.2012.43.4738] [Citation(s) in RCA: 315] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the prognostic significance of the international European LeukemiaNet (ELN) guidelines for reporting genetic alterations in acute myeloid leukemia (AML). PATIENTS AND METHODS We analyzed 1,550 adults with primary AML, treated on Cancer and Leukemia Group B first-line trials, who had pretreatment cytogenetics and, for cytogenetically normal patients, mutational status of NPM1, CEBPA, and FLT3 available. We compared complete remission (CR) rates, disease-free survival (DFS), and overall survival (OS) among patients classified into the four ELN genetic groups (favorable, intermediate-I, intermediate-II, adverse) separately for 818 younger (age < 60 years) and 732 older (age ≥ 60 years) patients. RESULTS The percentages of younger versus older patients in the favorable (41% v 20%; P < .001), intermediate-II (19% v 30%; P < .001), and adverse (22% v 31%; P < .001) genetic groups differed. The favorable group had the best and the adverse group the worst CR rates, DFS, and OS in both age groups. Both intermediate groups had significantly worse outcomes than the favorable but better than the adverse group. Intermediate-I and intermediate-II groups in older patients had similar outcomes, whereas the intermediate-II group in younger patients had better OS but not better CR rates or DFS than the intermediate-I group. The prognostic significance of ELN classification was confirmed by multivariable analyses. For each ELN group, older patients had worse outcomes than younger patients. CONCLUSION The ELN classification clearly separates the genetic groups by outcome, supporting its use for risk stratification in clinical trials. Because they have different proportions of genetic alterations and outcomes, younger and older patients should be reported separately when using the ELN classification.
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Affiliation(s)
- Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210-1228, USA.
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Mendler JH, Maharry K, Radmacher MD, Mrózek K, Becker H, Metzeler KH, Schwind S, Whitman SP, Khalife J, Kohlschmidt J, Nicolet D, Powell BL, Carter TH, Wetzler M, Moore JO, Kolitz JE, Baer MR, Carroll AJ, Larson RA, Caligiuri MA, Marcucci G, Bloomfield CD. RUNX1 mutations are associated with poor outcome in younger and older patients with cytogenetically normal acute myeloid leukemia and with distinct gene and MicroRNA expression signatures. J Clin Oncol 2012; 30:3109-18. [PMID: 22753902 DOI: 10.1200/jco.2011.40.6652] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine the association of RUNX1 mutations with therapeutic outcome in younger and older patients with primary cytogenetically normal acute myeloid leukemia (CN-AML) and with gene/microRNA expression signatures. PATIENTS AND METHODS Younger (< 60 years; n = 175) and older (≥ 60 years; n = 225) patients with CN-AML treated with intensive cytarabine/anthracycline-based first-line therapy on Cancer and Leukemia Group B protocols were centrally analyzed for RUNX1 mutations by polymerase chain reaction and direct sequencing and for established prognostic gene mutations. Gene/microRNA expression profiles were derived using microarrays. RESULTS RUNX1 mutations were found in 8% and 16% of younger and older patients, respectively (P = .02). They were associated with ASXL1 mutations (P < .001) and inversely associated with NPM1 (P < .001) and CEBPA (P = .06) mutations. RUNX1-mutated patients had lower complete remission rates (P = .005 in younger; P = .006 in older) and shorter disease-free survival (P = .058 in younger; P < .001 in older), overall survival (P = .003 in younger; P < .001 in older), and event-free survival (P < .001 for younger and older) than RUNX1 wild-type patients. Because RUNX1 mutations were more common in older patients and almost never coexisted with NPM1 mutations, RUNX1 mutation-associated expression signatures were derived in older, NPM1 wild-type patients and featured upregulation of genes normally expressed in primitive hematopoietic cells and B-cell progenitors, including DNTT, BAALC, BLNK, CD109, RBPMS, and FLT3, and downregulation of promoters of myelopoiesis, including CEBPA and miR-223. CONCLUSION RUNX1 mutations are twice as common in older than younger patients with CN-AML and negatively impact outcome in both age groups. RUNX1-mutated blasts have molecular features of primitive hematopoietic and lymphoid progenitors, potentially leading to novel therapeutic approaches.
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Affiliation(s)
- Jason H Mendler
- The Ohio State University, Comprehensive Cancer Center, 1216 James Cancer Hospital, 300 West 10th Ave, Columbus, OH 43210, USA
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Whitman SP, Caligiuri MA, Maharry K, Radmacher MD, Kohlschmidt J, Becker H, Mrózek K, Wu YZ, Schwind S, Metzeler KH, Mendler JH, Wen J, Baer MR, Powell BL, Carter TH, Kolitz JE, Wetzler M, Carroll AJ, Larson RA, Marcucci G, Bloomfield CD. The MLL partial tandem duplication in adults aged 60 years and older with de novo cytogenetically normal acute myeloid leukemia. Leukemia 2012; 26:1713-7. [PMID: 22382894 DOI: 10.1038/leu.2012.34] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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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Marcucci G, Metzeler KH, Schwind S, Becker H, Maharry K, Mrózek K, Radmacher MD, Kohlschmidt J, Nicolet D, Whitman SP, Wu YZ, Powell BL, Carter TH, Kolitz JE, Wetzler M, Carroll AJ, Baer MR, Moore JO, Caligiuri MA, Larson RA, Bloomfield CD. Age-related prognostic impact of different types of DNMT3A mutations in adults with primary cytogenetically normal acute myeloid leukemia. J Clin Oncol 2012; 30:742-50. [PMID: 22291079 DOI: 10.1200/jco.2011.39.2092] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the frequency of DNMT3A mutations, their associations with clinical and molecular characteristics and outcome, and the associated gene- and microRNA-expression signatures in primary cytogenetically normal acute myeloid leukemia (CN-AML). PATIENTS AND METHODS Four hundred fifteen previously untreated adults were analyzed for DNMT3A mutations and established prognostic gene mutations and expression markers. Gene- and microRNA-expression profiles were derived using microarrays. RESULTS Younger (< 60 years; n = 181) and older (≥ 60 years; n = 234) patients had similar frequencies of DNMT3A mutations (35.3% v 33.3%). Missense mutations affecting arginine codon 882 (R882-DNMT3A) were more common (n = 92; 62%) than those affecting other codons (non-R882-DNMT3A). DNMT3A-mutated patients did not differ regarding complete remission rate, but had shorter disease-free survival (DFS; P = .03) and, by trend, overall survival (OS; P = .07) than DNMT3A-wild-type patients. In multivariable analyses, DNMT3A mutations remained associated with shorter DFS (P = .01), but not with shorter OS. When analyzed separately, the two DNMT3A mutation types had different significance by age group. Younger patients with non-R882-DNMT3A mutations had shorter DFS (P = .002) and OS (P = .02), whereas older patients with R882-DNMT3A mutations had shorter DFS (P = .005) and OS (P = .002) after adjustment for other clinical and molecular prognosticators. Gene- and microRNA-expression signatures did not accurately predict DNMT3A mutational status. CONCLUSION DNMT3A mutations are frequent in CN-AML, and their clinical significance seems to be age dependent. DNMT3A-R882 mutations are associated with adverse prognosis in older patients, and non-R882-DNMT3A mutations are associated with adverse prognosis in younger patients. Low accuracy of gene- and microRNA-expression signatures in predicting DNMT3A mutation status suggested that the role of these mutations in AML remains to be elucidated.
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Affiliation(s)
- Guido Marcucci
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA.
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Becker H, Maharry K, Radmacher MD, Mrózek K, Metzeler KH, Whitman SP, Schwind S, Kohlschmidt J, Wu YZ, Powell BL, Carter TH, Kolitz JE, Wetzler M, Carroll AJ, Baer MR, Moore JO, Caligiuri MA, Larson RA, Marcucci G, Bloomfield CD. Clinical outcome and gene- and microRNA-expression profiling according to the Wilms tumor 1 (WT1) single nucleotide polymorphism rs16754 in adult de novo cytogenetically normal acute myeloid leukemia: a Cancer and Leukemia Group B study. Haematologica 2011; 96:1488-95. [PMID: 21659357 PMCID: PMC3186310 DOI: 10.3324/haematol.2011.041905] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 02/07/2011] [Revised: 05/12/2011] [Accepted: 06/06/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The alleles of the Wilms tumor 1 (WT1) polymorphism rs16754 harbor adenine (A) or guanine (G). Recently, rs16754 has been reported to affect the outcome of patients with cytogenetically normal acute myeloid leukemia. To validate this finding, we investigated pretreatment features and outcome associated with rs16754 in a large cohort of patients with cytogenetically normal acute myeloid leukemia. DESIGN AND METHODS Four-hundred and thirty-three intensively treated and molecularly characterized cytogenetically normal patients with de novo acute myeloid leukemia (18-83 years old) were analyzed for rs16754. To gain biological insights, we studied the gene- and microRNA-expression profiles for associations with rs16754. RESULTS Three-hundred and nine (71%) patients were homozygous for A (WT1(AA)), 112 (26%) were heterozygous (WT1(AG)) and 12 (3%) were homozygous for G (WT1(GG)). For comparison with previous studies, we grouped WT1(AG) and WT1(GG) patients and compared them with WT1(AA) patients divided into younger (<60 years) and older (≥60 years) adults. We found no independent prognostic impact of WT1(AA). However, WT1(GG) patients, who were less often Caucasian than WT1(AG) (P=0.001) or WT1(AA) (P=0.008) patients, and had TET2 mutations more often than WT1(AG) (P=0.02) patients, had, among patients with FLT3-internal tandem duplication and/or NPM1 wild-type, better disease-free (P=0.02) and overall survival (P=0.04) than WT1(AA) and WT1(AG) patients combined. Unsupervised and supervised analyses of the gene- and microRNA-expression profiles suggested that there were no distinct expression patterns associated with any rs16754 genotype. CONCLUSIONS We did not observe the previously reported adverse impact of WT1(AA) but found favorable outcomes associated with the homozygous WT1(GG). Considering its low frequency, confirmatory studies are necessary. The biological significance of rs16754 remains questionable as no distinct expression profiles were associated with the genotypes.
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Affiliation(s)
- Heiko Becker
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kati Maharry
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- The Cancer and Leukemia Group B Statistical Center, Duke University Medical Center, Durham, NC, USA
| | - Michael D. Radmacher
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- The Cancer and Leukemia Group B Statistical Center, Duke University Medical Center, Durham, NC, USA
| | - Krzysztof Mrózek
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Klaus H. Metzeler
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Susan P. Whitman
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Sebastian Schwind
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Jessica Kohlschmidt
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- The Cancer and Leukemia Group B Statistical Center, Duke University Medical Center, Durham, NC, USA
| | - Yue-Zhong Wu
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Bayard L. Powell
- Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, USA
| | | | | | | | | | | | | | - Michael A. Caligiuri
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Guido Marcucci
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Clara D. Bloomfield
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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