PURPOSE: The biological and clinical heterogeneity of chronic myelomonocytic leukemia features renders its classification difficult. Moreover, because of the limited knowledge of the mechanisms involved in malignant evolution, chronic myelomonocytic leukemia remains a diagnostic and therapeutic challenge and a poor prognosis disease. We aimed to verify the biological and clinical significance of the discrimination, based on the leukocyte count, between myelodysplastic chronic myelomonocytic leukemia (MD-CMML) and myeloproliferative chronic myelomonocytic leukemia (MP-CMML). EXPERIMENTAL DESIGN: Peripheral blood samples from 22 patients classified as MD-CMML and 18 as MP-CMML were collected at different time points during disease course, and patients' clinical characteristics were examined. RAS mutational screening was done by sequencing and, for each substitution identified, a highly selective allele-specific PCR was set up to screen all specimens. RESULTS: MP-CMML patients showed a significantly poorer survival (P = 0.003) and a higher frequency of RAS mutations (P = 0.033) by sequencing compared with MD-CMML. Overall, five MD-CMML patients progressed to myeloproliferative disease: in two, allele-specific PCR unveiled low levels of the RAS mutations predominating in the myeloproliferative phase at the time of myelodysplastic disease, documenting for the first time the expansion of a RAS mutated clone in concomitance with chronic myelomonocytic leukemia evolution. Moreover, one of the progressed patients harbored the FLT3-ITD and two MP-CMML patients presented with the JAK2 V617F substitution. All these lesions were mutually exclusive. CONCLUSIONS: Our results strongly suggest RAS mutations to function as a secondary event that contributes to development of the chronic myelomonocytic leukemia variant with the poorer prognosis (MP-CMML) and therefore advise their detection to be implemented in chronic myelomonocytic leukemia diagnostics and monitoring.
PURPOSE: The biological and clinical heterogeneity of chronic myelomonocytic leukemia features renders its classification difficult. Moreover, because of the limited knowledge of the mechanisms involved in malignant evolution, chronic myelomonocytic leukemia remains a diagnostic and therapeutic challenge and a poor prognosis disease. We aimed to verify the biological and clinical significance of the discrimination, based on the leukocyte count, between myelodysplastic chronic myelomonocytic leukemia (MD-CMML) and myeloproliferative chronic myelomonocytic leukemia (MP-CMML). EXPERIMENTAL DESIGN: Peripheral blood samples from 22 patients classified as MD-CMML and 18 as MP-CMML were collected at different time points during disease course, and patients' clinical characteristics were examined. RAS mutational screening was done by sequencing and, for each substitution identified, a highly selective allele-specific PCR was set up to screen all specimens. RESULTS:MP-CMMLpatients showed a significantly poorer survival (P = 0.003) and a higher frequency of RAS mutations (P = 0.033) by sequencing compared with MD-CMML. Overall, five MD-CMMLpatients progressed to myeloproliferative disease: in two, allele-specific PCR unveiled low levels of the RAS mutations predominating in the myeloproliferative phase at the time of myelodysplastic disease, documenting for the first time the expansion of a RAS mutated clone in concomitance with chronic myelomonocytic leukemia evolution. Moreover, one of the progressed patients harbored the FLT3-ITD and two MP-CMMLpatients presented with the JAK2 V617F substitution. All these lesions were mutually exclusive. CONCLUSIONS: Our results strongly suggest RAS mutations to function as a secondary event that contributes to development of the chronic myelomonocytic leukemia variant with the poorer prognosis (MP-CMML) and therefore advise their detection to be implemented in chronic myelomonocytic leukemia diagnostics and monitoring.
Authors: Heather Mason-Suares; Diana Toledo; Jean Gekas; Katherine A Lafferty; Naomi Meeks; M Cristina Pacheco; David Sharpe; Thomas E Mullen; Matthew S Lebo Journal: Eur J Hum Genet Date: 2017-01-18 Impact factor: 4.246
Authors: Liping Zhang; Rajesh R Singh; Keyur P Patel; Francesco Stingo; Mark Routbort; M James You; Roberto N Miranda; Guillermo Garcia-Manero; Hagop M Kantarjian; L Jeffrey Medeiros; Rajyalakshmi Luthra; Joseph D Khoury Journal: Am J Hematol Date: 2014-02-10 Impact factor: 10.047
Authors: Gautam Borthakur; Leslie Popplewell; Michael Boyiadzis; James Foran; Uwe Platzbecker; Norbert Vey; Roland B Walter; Rebecca Olin; Azra Raza; Aristoteles Giagounidis; Aref Al-Kali; Elias Jabbour; Tapan Kadia; Guillermo Garcia-Manero; John W Bauman; Yuehui Wu; Yuan Liu; Dan Schramek; Donna S Cox; Paul Wissel; Hagop Kantarjian Journal: Cancer Date: 2016-03-18 Impact factor: 6.860