Recent progress in next-generation sequencing technologies has shown that tumor cells in many solid cancers undergo dynamic clonal evolution. 1 Notably, diverse clones have been observed in biopsy ...samples acquired from primary or metastatic legions in solid cancers. 2-4 In contrast, intratumor heterogeneity (ITH) in lymphomas is less characterized: samples are taken only for diagnosis and multiregional sample collection is rarely performed in living patients, because chemotherapy rather than surgery is the standard treatment for most lymphoma subtypes. Black dots indicate a tumor mass; organs with red diagonal lines represent intravascular tumor invasions. kid, kidney; ll, left lung; lym, lymph node; rl1, right lung; spl, spleen. ...this analysis shows a clear phylogenic tree of aggressive lymphoma, confirming that dynamic time-dependent and spatial ITH occurs even in systemic disease.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Triple-negative essential thrombocythemia (ET) is a condition in which mutations in JAK2, CALR and MPL are all negative. Transformation to acute myeloid leukemia may occur during the course of ET, ...while B-acute lymphoblastic leukemia B-(ALL) is rare. We experienced a case diagnosed as B-ALL during the course of triple-negative ET. Notably, cytoreduction was required for the excessive increase in blood cells during the bone marrow recovery period after chemotherapies. Whole exome sequencing identified 17 somatic mutations: 9 were identified in both ET and B-ALL samples, while 8 were specific to B-ALL, suggesting that these 8 might have caused the transformation.
Objective Graft failure (GF) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT). A standardized conditioning regimen and an appropriate graft source of salvage HSCT ...for GF have not yet been established. Some case series have shown good hematopoietic recoveries after salvage HSCT using a short-term reduced-intensity preparative regimen consisting of fludarabine (30-90 mg/m2), cyclophosphamide (2 g/m2), and total-body irradiation (2 Gy). However, the dose of fludarabine has varied in these reports based on the clinical condition of the patients, resulting in very limited experiences with each dose of fludarabine. Methods We retrospectively analyzed 10 patients who developed GF after allogeneic HSCT and underwent salvage cord blood transplantation (CBT) using the above-mentioned conditioning regimen with a fixed dose (90 mg/m2) of fludarabine. Results Eight patients (80.0%) achieved neutrophil engraftment within 30 days from salvage HSCT with a median of 21 (range, 17-23) days. The 1-year overall survival (OS) rate after the salvage HSCT was 50.0%, and the median OS was 281 (range, 23-1,638) days. Cumulative incidences of non-relapse mortality and relapse at 1 year were 50.0% and 10.0%, respectively. Conclusion CBT using this short-term reduced-intensity conditioning regimen may be a promising salvage therapy for GF.
Background
Hypomethylating agents, including azacytidine (AZA), are standard therapeutics for patients with high‐risk myelodysplastic syndromes (MDS), a group of myeloid neoplasms. However, treatment ...schedules are not unified in real‐world practice; in addition to the standard 7‐day (standard‐dose) schedule, shortened (reduced‐dose) schedules are also used.
Aims
The aim of this study was to discover the patient group(s) which show differential efficacy between standard‐and reduced‐dose AZA to MDS.
Methods and Results
The outcome of different AZA doses in a cohort of 151 MDS patients were retrospectively analyzed. Overall survival (OS) was not significantly different between standard‐ and reduced‐dose AZA groups by multivariate analysis. However, an interaction was found between either the sex (female vs. male), the platelet counts (< 40 × 103/μl vs. ≥ 40 × 103/μl), or the karyotype risk (< poor vs. ≥ poor) and standard‐dose AZA for longer OS. Subgroup analyses revealed better OS with standard‐ over reduced‐dose AZA in female patients (HR, 0.27 95% CI, 0.090‐0.79; p = 0.011), and those with platelet counts ≥ 40 × 103/μl (HR, 0.51 95% CI, 0.26‐0.99; p = 0.041). The union of female and preserved platelet count subgroups also benefited from standard‐dose AZA. With this as a test cohort, we next analyzed patients registered in the JALSG MDS212 study, for whom 7‐day and 5‐day AZA treatment strategies were prospectively compared, as a validation cohort (N = 172). That cohort showed the same tendency as the retrospective results.
Conclusion
We identified the union of female and preserved platelet count subgroups which benefited from standard‐dose AZA, imparting crucial information to physicians planning treatment regimens in MDS patients.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
8.
Clonal Hematopoiesis and Solid Cancer Sakata-Yanagimoto, Mamiko; Makishima, Kenichi; Suehara, Yasuhito
Gan to kagaku ryoho
50, Issue:
2
Journal Article
Peer reviewed
In the hematopoietic system of healthy individuals, a phenomenon called clonal hematopoiesis, in which cells acquired somatic mutations are replaced with aging, has been discovered. The frequency of ...clonal hematopoiesis is higher in patients with solid tumors, than normal individuals. In addition, it is thought that infiltration of inflammatory cells with somatic mutations into cancer tissues may change the tumor microenvironment. Since clonal hematopoiesis is often found incidentally in gene panel testing of solid cancer tissues, it is of great significance to have an insight into clonal hematopoiesis in the medical care of solid cancer patients. In this paper, we describe the general concept of clonal hematopoiesis, the frequency of clonal hematopoiesis in patients with solid tumors, the characteristics of the clinical course in patients with clonal hematopoiesis, and microscopic observations of solid tumors in mouse models of clonal hematopoiesis.
We report the case of a 76-year-old man who was diagnosed as having chronic myeloid leukemia (CML) with p190 BCR-ABL while receiving treatment for symptomatic multiple myeloma (MM). The diagnosis of ...MM was based on the presence of serum M-protein, abnormal plasma cells in the bone marrow, and lytic bone lesions. The patient achieved a partial response to lenalidomide and dexamethasone treatment. However, 2 years after the diagnosis of MM, the patient developed leukocytosis with granulocytosis, anemia, and thrombocytopenia. Bone marrow examination revealed Philadelphia chromosomes and chimeric p190 BCR-ABL mRNA. Fluorescence in situ hybridization also revealed BCR-ABL-positive neutrophils in the peripheral blood, which suggested the emergence of CML with p190 BCR-ABL. The codevelopment of MM and CML is very rare, and this is the first report describing p190 BCR-ABL-type CML coexisting with MM. Moreover, we have reviewed the literature regarding the coexistence of these diseases.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
•ACH-derived GCB cells with aberrant expression profiles underwent independent clonal evolution in the microenvironment of AITL.•Inhibition of the CD40–CD40LG axis, as revealed by in silico network ...analysis, is a potential novel therapeutic target.
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Angioimmunoblastic T-cell lymphoma (AITL) is proposed to be initiated by age-related clonal hematopoiesis (ACH) with TET2 mutations, whereas the G17V RHOA mutation in immature cells with TET2 mutations promotes the development of T follicular helper (TFH)-like tumor cells. Here, we investigated the mechanism by which TET2-mutant immune cells enable AITL development using mouse models and human samples. Among the 2 mouse models, mice lacking Tet2 in all the blood cells (Mx-Cre × Tet2flox/flox × G17V RHOA transgenic mice) spontaneously developed AITL for approximately up to a year, while mice lacking Tet2 only in the T cells (Cd4-Cre × Tet2flox/flox × G17V RHOA transgenic mice) did not. Therefore, Tet2-deficient immune cells function as a niche for AITL development. Single-cell RNA-sequencing (scRNA-seq) of >50 000 cells from mouse and human AITL samples revealed significant expansion of aberrant B cells, exhibiting properties of activating light zone (LZ)-like and proliferative dark zone (DZ)-like germinal center B (GCB) cells. The GCB cells in AITL clonally evolved with recurrent mutations in genes related to core histones. In silico network analysis using scRNA-seq data identified Cd40–Cd40lg as a possible mediator of GCB and tumor cell cluster interactions. Treatment of AITL model mice with anti-Cd40lg inhibitory antibody prolonged survival. The genes expressed in aberrantly expanded GCB cells in murine tumors were also broadly expressed in the B-lineage cells of TET2-mutant human AITL. Therefore, ACH-derived GCB cells could undergo independent clonal evolution and support the tumorigenesis in AITL via the CD40–CD40LG axis.
The second most common peripheral T-cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), arises from T-follicular helper cells in the context of age-related clonal hematopoiesis. Fujisawa and colleagues utilized single cell analyses of primary samples and murine models to reveal that TET methylcytosine dioxygenase 2 (TET2) mutations within clonal B cells in the tumor microenvironment are necessary for facilitating TET2-mutated AITL. Their data also suggest a novel therapeutic possibility.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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