RESUMO
By combining the analysis of mutations with aberrant expression of genes previously related to poorer prognosis in both acute promyelocytic leukemia (APL) and acute myeloid leukemia, we arrived at an integrative score in APL (ISAPL) and demonstrated its relationship with clinical outcomes of patients treated with all-trans retinoic acid (ATRA) in combination with anthracycline-based chemotherapy. Based on fms-like tyrosine kinase-3-internal tandem duplication mutational status; the ΔNp73/TAp73 expression ratio; and ID1, BAALC, ERG, and KMT2E gene expression levels, we modeled ISAPL in 159 patients (median ISAPL score, 3; range, 0-10). ISAPL modeling identified 2 distinct groups of patients, with significant differences in early mortality (P < .001), remission (P = .004), overall survival (P < .001), cumulative incidence of relapse (P = .028), disease-free survival (P = .03), and event-free survival (P < .001). These data were internally validated by using a bootstrap resampling procedure. At least for patients treated with ATRA and anthracycline-based chemotherapy, ISAPL modeling may identify those who need to be treated differently to maximize their chances for a cure.
Assuntos
Biomarcadores Tumorais/genética , Análise Mutacional de DNA , Perfilação da Expressão Gênica , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/genética , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Farmacológicos/análise , Biomarcadores Tumorais/análise , Estudos de Coortes , Análise Mutacional de DNA/métodos , Feminino , Perfilação da Expressão Gênica/métodos , Regulação Leucêmica da Expressão Gênica/efeitos dos fármacos , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/patologia , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/métodos , Mutação , Prognóstico , Sequências de Repetição em Tandem/genética , Transcriptoma , Resultado do Tratamento , Tretinoína/administração & dosagem , Adulto Jovem , Tirosina Quinase 3 Semelhante a fms/genéticaRESUMO
Despite great advance in multiple myeloma (MM) treatment since 2000s, it is still an incurable disease and novel therapies are welcome. Therefore, the purpose of this study was to explore MM plasma cells' (MM-PC) proteome, in comparison with their normal counterparts (derived from palatine tonsils of normal donors, ND-PC), in order to find potential therapeutic targets expressed on the surface of these cells. We also aimed to evaluate the proteome of MM cell lines with different genetic alterations, to confirm findings obtained with primary tumor cells. Bone marrow (BM) samples from eight new cases of MM and palatine tonsils from seven unmatched controls were submitted to PC separation and, in addition to two MM cell lines (U266, RPMI-8226), were submitted to protein extraction for mass spectrometry analyses. A total of 81 proteins were differentially expressed between MM-PC and ND-PC - 72 upregulated and nine downregulated; U266 vs. RPMI 8226 cell lines presented 61 differentially expressed proteins - 51 upregulated and 10 downregulated. On primary tumors, bioinformatics analyses highlighted upregulation of protein biosynthesis machinery, as well as downregulation of immune response components, such as MHC class I and II, and complement receptors. We also provided comprehensive information about U266 and RPMI-8226 cell lines' proteome and could confirm some patients' findings.
RESUMO
The KMT2E (MLL5) gene encodes a histone methyltransferase implicated in the positive control of genes related to haematopoiesis. Its close relationship with retinoic acid-induced granulopoiesis suggests that the deregulated expression of KMT2E might lead acute promyelocytic leukaemia (APL) blasts to become less susceptible to the conventional treatment protocols. Here, we assessed the impact of KMT2E expression on the prognosis of 121 APL patients treated with ATRA and anthracycline-based chemotherapy. Univariate analysis showed that complete remission (P = 0·006), 2-year overall survival (OS) (P = 0·005) and 2-year disease-free survival (DFS) rates (P = 0·037) were significantly lower in patients with low KMT2E expression; additionally, the 2-year cumulative incidence of relapse was higher in patients with low KMT2E expression (P = 0·04). Multivariate analysis revealed that low KMT2E expression was independently associated with lower remission rate (odds ratio [OR]: 7·18, 95% confidence interval [CI]: 1·71-30·1; P = 0·007) and shorter OS (hazard ratio [HR]: 0·27, 95% CI: 0·08-0·87; P = 0·029). Evaluated as a continuous variable, KMT2E expression retained association with poor remission rate (OR: 10·3, 95% CI: 2·49-43·2; P = 0·001) and shorter survival (HR: 0·17, 95% IC: 0·05-0·53; P = 0·002), while the association with DFS was of marginal significance (HR: 1·01; 95% CI: 0·99-1·02; P = 0·06). In summary, low KMT2E expression may predict poor outcome in APL patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Proteínas de Ligação a DNA/metabolismo , Leucemia Promielocítica Aguda/tratamento farmacológico , Adolescente , Adulto , Antraciclinas/administração & dosagem , Estudos de Casos e Controles , Feminino , Humanos , Leucemia Promielocítica Aguda/metabolismo , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tretinoína/administração & dosagem , Adulto JovemRESUMO
BACKGROUND: Multiparameter flow cytometry is a useful tool for the diagnostic evaluation of mature B-cell neoplasms (MBN). Recently, it has been shown that CD200 may improve the distinction between chronic lymphocytic leukemia (CLL; CD200+) and mantle cell lymphoma (MCL; CD200-), but the role of CD200 expression in atypical CLL and other MBN remains to be established. METHODS: To address this issue, we investigated the expression of CD200 in 159 consecutive cases of MBN. RESULTS: CD200 was strongly expressed in CLL and was revealed to be an excellent marker to distinguish CLL from MCL, even in cases of atypical CLL. However, lack of CD200 was not an exclusive finding of MCL, being also observed in other MBNs. Furthermore, CD200 was highly expressed in hairy cell leukemia, being useful in the differential diagnosis of lymphomas with villous lymphocytes. Herein, we propose an algorithm to classify CD5+ MBNs based on the expression of CD200, CD11c, heavy chain immunoglobulins, and Matutes score. CONCLUSIONS: These results expand the understanding of the CD200 expression in MBNs, giving further support for the inclusion of this marker in the routine investigation by flow cytometry.
Assuntos
Antígenos CD/análise , Citometria de Fluxo , Leucemia Linfocítica Crônica de Células B/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD/imunologia , Diagnóstico Diferencial , Feminino , Humanos , Imunofenotipagem , Leucemia Linfocítica Crônica de Células B/imunologia , Linfoma de Célula do Manto/diagnóstico , Linfoma de Célula do Manto/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
Background: Multiparameter flow cytometry is a useful tool for the diagnostic evaluation of mature B-cell neoplasms (MBN). Recently, it has been shown that CD200 may improve the distinction between chronic lymphocytic leukemia (CLL; CD200+) and mantle cell lymphoma (MCL; CD200-), but the role of CD200 expression in atypical CLL and other MBN remains to be established. Methods: To address this issue, we investigated the expression of CD200 in 159 consecutive cases of MBN. Results: CD200 was strongly expressed in CLL and was revealed to be an excellent marker to distinguish CLL from MCL, even in cases of atypical CLL. However, lack of CD200 was not an exclusive finding of MCL, being also observed in other MBNs. Furthermore, CD200 was highly expressed in hairy cell leukemia, being useful in the differential diagnosis of lymphomas with villous lymphocytes. Herein, we propose an algorithm to classify CD5+ MBNs based on the expression of CD200, CD11c, heavy chain immunoglobulins and Matutes score. Conclusions: These results expand the understanding of the CD200 expression in MBNs, giving further support for the inclusion of this marker in the routine investigation by flow cytometry. © 2013 Clinical Cytometry Society.
RESUMO
This paper chronicles a 2-year-old girl who presented with acute leukemia/lymphoma syndrome of the T cell immunophenotype. At this time, the cytogenetic analysis of her bone marrow cells showed a reciprocal translocation between the short arm of chromosome 12 and the long arm of chromosome 13, t(12;13)(p13;q14). The immunophenotyping of bone marrow blast cells by flow cytometry revealed a population of cells positive for CD56, CD117, CD45, partial CD33, partial HLA-DR, CD13, CD7, CD2 and CD5. Therefore, a diagnosis of acute leukemia with a mixed T cell/myeloid phenotype was made. The patient had a poor response to classic T cell acute lymphocytic leukemia/lymphoma therapy; thus, her treatment was changed to a myeloid leukemia protocol, which produced a good response. She underwent a successful cord blood transplantation from an unrelated HLA partially matched donor. The coexistence of these two phenotypes prompts questions about the existence of clonal instability, which might influence the choice of therapy. The rarity of the t(12;13)(p13;q14) and the coexistence of T cell/myeloid markers suggest a nonrandom association. To the best of our knowledge, this is the first reported case in which a cell clone bearing a t(12;13)(p13;q14) translocation in a mixed T cell/myeloid lesion was detected.
Assuntos
Leucemia Mieloide/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Receptores de Antígenos de Linfócitos T/genética , Translocação Genética , Doença Aguda , Antígenos CD/análise , Pré-Escolar , Cromossomos Humanos Par 12/genética , Cromossomos Humanos Par 13/genética , Feminino , Antígenos HLA-DR/análise , Humanos , Imunofenotipagem , Hibridização in Situ Fluorescente , Cariotipagem , Leucemia Mieloide/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Proteínas Proto-Oncogênicas c-ets/genética , Proteínas Repressoras/genética , Variante 6 da Proteína do Fator de Translocação ETSRESUMO
Translocation (8;21)(q22;q22)/RUNX1-RUNX1T1 is a molecular marker that is usually associated with a favorable outcome in both pediatric and adult patients with acute myeloid leukemia (AML). The present report describes the results of hematologic, cytogenetic, and fluorescence in situ hybridization analysis of a case of AML with maturation in a 23-year-old woman. Cytogenetic analysis revealed a balanced translocation involving chromosomal band 21q22, which disrupts the RUNX1 gene, and 10q22, with the following karyotype: 45,X,-X,t(10;21)(q24;q22)[cp16]/46,XX [4]. Interphase FISH showed, in 67% of the 300 interphase nuclei analyzed, three signals for RUNX1 and two RUNX1T1, but no signals corresponding to RUNX1-RUNX1T1 fusion gene. These results were corroborated by RT-PCR, which revealed negative results for the amplification of RUNX1-RUNX1T1 fusion gene. The patient was refractory to conventional and salvage chemotherapy regimens and early relapsed after unrelated donor bone marrow transplantation (BMT), dying of pneumonia, acute respiratory failure, and sepsis on day +80 after BMT, 1 year after diagnosis.
Assuntos
Cromossomos Humanos Par 10/genética , Cromossomos Humanos Par 21/genética , Subunidade alfa 2 de Fator de Ligação ao Core/genética , Leucemia Mieloide Aguda/genética , Translocação Genética/genética , Adulto , Transplante de Medula Óssea , Evolução Fatal , Feminino , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , Leucemia Mieloide Aguda/terapia , Doadores não Relacionados , Adulto JovemAssuntos
Leucemia Mieloide Aguda/genética , Tirosina Quinase 3 Semelhante a fms/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Análise Mutacional de DNA , Feminino , Testes Genéticos , Humanos , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Mutação/genética , Adulto JovemAssuntos
Aberrações Cromossômicas , Leucemia Promielocítica Aguda/genética , Tirosina Quinase 3 Semelhante a fms/genética , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Cromossomos Humanos Par 15 , Cromossomos Humanos Par 17 , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mutação , Translocação Genética , Adulto JovemAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Linfoma não Hodgkin/tratamento farmacológico , Trombocitemia Essencial/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/efeitos adversos , Prednisolona/uso terapêutico , Vincristina/efeitos adversos , Vincristina/uso terapêuticoRESUMO
We report on a girl who, despite her 45,X/46,X,der(Y) karyotype, showed no signs of virilization or physical signs of the Ullrich-Turner syndrome (UTS), except for a reduced growth rate. After prophylactic gonadectomy due to the risk of developing gonadoblastoma, the gonads and peripheral blood samples were analyzed by fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) to detect Y-specific sequences. These analyses allowed us to characterize the Y-derived chromosome as being an isodicentric Yp chromosome (idic(Yp)) and showed a pronounced difference in the distribution of the 45,X/46,X,idic(Yp) mosaicism between the two analyzed tissues. It was shown that, although in peripheral blood almost all cells (97.5%) belonged to the idic(Yp) line with a duplicated SRY gene, this did not determine any degree of male sexual differentiation in the patient, as in the gonads the predominant cell line was 45,X (60%).