Comparison of therapy-related and de novo core binding factor acute myeloid leukemia: A bone marrow pathology group study
AMERICAN JOURNAL OF HEMATOLOGY
Authors: Rogers, Heesun J.; Wang, Xiaoqiong; Xie, Yan; Davis, Adam R.; Thakral, Beenu; Wang, Sa A.; Borthakur, Gautam; Cantu, Miguel D.; Margolskee, Elizabeth M.; Philip, John K. S.; Sukhanova, Madina; Bagg, Adam; Bueso-Ramos, Carlos E.; Orazi, Attilio; Arber, Daniel A.; Hsi, Eric D.; Hasserjian, Robert P.
Abstract
This multi-institutional study retrospectively evaluated clinicopathologic and genetic characteristics in 351 patients with core-binding-factor acute myeloid leukemia (CBF-AML), comprising 69 therapy-related (t-CBF-AML) and 282 de novo cases. The T-CBF-AML patients were older, had lower WBC counts, and slightly higher hemoglobin than patients with de novo disease. Secondary cytogenetic abnormalities were more frequent in patients with de novo disease than t-CBF-AML (57.1% vs 41.1%, P = .026). Patients with secondary cytogenetic abnormalities had longer overall survival (OS) than those without abnormalities (median 190 vs 87 months, P = .021); trisomy 8, trisomy 22, and loss of the X or Y chromosome were associated with longer OS. In the 165 cases performed of targeted gene sequencing, pathogenic mutations were detected in 75.7% of cases, and were more frequent in de novo than in therapy-related disease (P = .013). Mutations were found in N/KRAS (37.0%), FLT3 (27.8%), KIT (17.2%), TET2 (4.9%), and ASXL1 (3.9%). The TET2 mutations were associated with shorter OS (P = .012) while N/KRAS mutation was associated with longer OS in t(8;21) AML patients (P = .001). The KIT mutation did not show prognostic significance in this cohort. Although they received similar therapy, t-CBF-AML patients had shorter OS than de novo patients (median 69 vs 190 months, P = .038). In multivariate analysis of all patients, older age and absence of any secondary cytogenetic abnormalities were significant predictors of shorter OS. Among the t-CBF-AML subset, age and hemoglobin were significant on multivariate analysis. This study demonstrated that although de novo and t-CBF-AML patients share many features, t-CBF-AML patients have worse clinical outcome than de novo patients.
Machine learning derived genomics driven prognostication for acute myeloid leukemia withRUNX1-RUNX1T1
LEUKEMIA & LYMPHOMA
Authors: Shaikh, Anam Fatima; Kakirde, Chinmayee; Dhamne, Chetan; Bhanshe, Prasanna; Joshi, Swapnali; Chaudhary, Shruti; Chatterjee, Gaurav; Tembhare, Prashant; Prasad, Maya; Moulik, Nirmalya Roy; Gokarn, Anant; Bonda, Avinash; Nayak, Lingaraj; Punatkar, Sachin; Jain, Hasmukh; Bagal, Bhausaheb; Shetty, Dhanalaxmi; Sengar, Manju; Narula, Gaurav; Khattry, Navin; Banavali, Shripad; Gujral, Sumeet; Subramanian, P. G.; Patkar, Nikhil
Abstract
Panel based next generation sequencing was performed on a discovery cohort of AML withRUNX1-RUNX1T1. Supervised machine learning identifiedNRASmutation and absence of mutations inASXL2, RAD21, KITandFLT3genes as well as a low mutation to be associated with favorable outcome. Based on this data patients were classified into favorable and poor genetic risk classes. Patients classified as poor genetic risk had a significantly lower overall survival (OS) and relapse free survival (RFS). We could validate these findings independently on a validation cohort (n = 61). Patients in the poor genetic risk group were more likely to harbor measurable residual disease. Poor genetic risk emerged as an independent risk factor predictive of inferior outcome. Using an unbiased computational approach based we provide evidence for gene panel-based testing in AML withRUNX1-RUNX1T1and a framework for integration of genomic markers toward clinical decision making in this heterogeneous disease entity.