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DeZern AE, Goll JB, Lindsley RC, Bejar R, Wilson SH, Hebert D, Deeg J, Zhang L, Gore S, Al Baghdadi T, Maciejewski J, Liu J, Padron E, Komrojki R, Saber W, Abel G, Kroft SH, Harrington A, Grimes T, Reed H, Fulton RS, DiFronzo NL, Gillis N, Sekeres MA, Walter MJ. Utility of targeted gene sequencing to differentiate myeloid malignancies from other cytopenic conditions. Blood Adv 2023; 7:3749-3759. [PMID: 36947201 PMCID: PMC10368770 DOI: 10.1182/bloodadvances.2022008578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023] Open
Abstract
The National Heart, Lung, and Blood Institute-funded National MDS Natural History Study (NCT02775383) is a prospective cohort study enrolling patients with cytopenia with suspected myelodysplastic syndromes (MDS) to evaluate factors associated with disease. Here, we sequenced 53 genes in bone marrow samples harvested from 1298 patients diagnosed with myeloid malignancy, including MDS and non-MDS myeloid malignancy or alternative marrow conditions with cytopenia based on concordance between independent histopathologic reviews (local, centralized, and tertiary to adjudicate disagreements when needed). We developed a novel 2-stage diagnostic classifier based on mutational profiles in 18 of 53 sequenced genes that were sufficient to best predict a diagnosis of myeloid malignancy and among those with a predicted myeloid malignancy, predict whether they had MDS. The classifier achieved a positive predictive value (PPV) of 0.84 and negative predictive value (NPV) of 0.8 with an area under the receiver operating characteristic curve (AUROC) of 0.85 when classifying patients as having myeloid vs no myeloid malignancy based on variant allele frequencies (VAFs) in 17 genes and a PPV of 0.71 and NPV of 0.64 with an AUROC of 0.73 when classifying patients as having MDS vs non-MDS malignancy based on VAFs in 10 genes. We next assessed how this approach could complement histopathology to improve diagnostic accuracy. For 99 of 139 (71%) patients (PPV of 0.83 and NPV of 0.65) with local and centralized histopathologic disagreement in myeloid vs no myeloid malignancy, the classifier-predicted diagnosis agreed with the tertiary pathology review (considered the internal gold standard).
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Affiliation(s)
| | | | | | | | | | | | - Joachim Deeg
- Fred Hutchison Cancer Research Center, Seattle, WA
| | | | - Steven Gore
- National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | | | | | | | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | | | | | | | | | | | - Robert S. Fulton
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Nancy L. DiFronzo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | | | - Matthew J. Walter
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
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Badar T, Szabo A, Sallman D, Komrojki R, Lancet J, Padron E, Song J, Hussaini MO. Interrogation of molecular profiles can help in differentiating between MDS and AML with MDS-related changes. Leuk Lymphoma 2020; 61:1418-1427. [DOI: 10.1080/10428194.2020.1719089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Talha Badar
- Division of Hematology and Oncology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Hematology and Oncology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, WI, USA
| | - David Sallman
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Rami Komrojki
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jefferey Lancet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jinming Song
- Department of Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL, USA
| | - Mohammad Omar Hussaini
- Department of Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL, USA
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