scholarly journals Personalized Medicine for TP53 Mutated Myelodysplastic Syndromes and Acute Myeloid Leukemia

2021 ◽  
Vol 22 (18) ◽  
pp. 10105
Author(s):  
Thomas Cluzeau ◽  
Michael Loschi ◽  
Pierre Fenaux ◽  
Rami Komrokji ◽  
David A. Sallman
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Current Knowledge ◽  
Unmet Need ◽  
New Drugs ◽  
Molecular Subgroup ◽  
Myeloid Neoplasms ◽  
Early Biomarker ◽  
Acute Myeloid

Targeting TP53 mutated myelodysplastic syndromes and acute myeloid leukemia remains a significant unmet need. Recently, new drugs have attempted to improve the outcomes of this poor molecular subgroup. The aim of this article is to review all the current knowledge using active agents including hypomethylating agents with venetoclax, eprenetapopt or magrolimab. We include comprehensive analysis of clinical trials to date evaluating these drugs in TP53 myeloid neoplasms as well as discuss future novel combinations for consideration. Additionally, further understanding of the unique clinicopathologic components of TP53 mutant myeloid neoplasms versus wild-type is critical to guide future study. Importantly, the clinical trajectory of patients is uniquely tied with the clonal burden of TP53, which enables serial TP53 variant allele frequency analysis to be a critical early biomarker in investigational studies. Together, significant optimism is now possible for improving outcomes in this patient population.

scholarly journals Current challenges and unmet medical needs in myelodysplastic syndromes

Leukemia ◽  
2021 ◽  
Author(s):  
Uwe Platzbecker ◽  
Anne Sophie Kubasch ◽  
Collin Homer-Bouthiette ◽  
Thomas Prebet
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Unmet Need ◽  
Standard Of Care ◽  
Medical Needs ◽  
Risk Of Progression ◽  
History Of ◽  
Patients Experience ◽  
Acute Myeloid

AbstractMyelodysplastic syndromes (MDS) represent a heterogeneous group of myeloid neoplasms that are characterized by ineffective hematopoiesis, variable cytopenias, and a risk of progression to acute myeloid leukemia. Most patients with MDS are affected by anemia and anemia-related symptoms, which negatively impact their quality of life. While many patients with MDS have lower-risk disease and are managed by existing treatments, there currently is no clear standard of care for many patients. For patients with higher-risk disease, the treatment priority is changing the natural history of the disease by delaying disease progression to acute myeloid leukemia and improving overall survival. However, existing treatments for MDS are generally not curative and many patients experience relapse or resistance to first-line treatment. Thus, there remains an unmet need for new, more effective but tolerable strategies to manage MDS. Recent advances in molecular diagnostics have improved our understanding of the pathogenesis of MDS, and it is becoming clear that the diverse nature of genetic abnormalities that drive MDS demands a complex and personalized treatment approach. This review will discuss some of the challenges related to the current MDS treatment landscape, as well as new approaches currently in development.

scholarly journals Comparison of in vitro growth characteristics of blast cell progenitors (CFU-L) in patients with myelodysplastic syndromes and acute myeloid leukemia

Blood ◽  
1992 ◽  
Vol 80 (3) ◽  
pp. 625-633 ◽  
Author(s):  
C Aul ◽  
N Gattermann ◽  
W Schneider
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Mononuclear Cells ◽  
Current Knowledge ◽  
Blast Cell ◽  
Growth Patterns ◽  
Self Renewal ◽  
Short Term Exposure ◽  
Acute Myeloid

Current knowledge is inadequate to explain the different patterns of blast cell accumulation in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). We compared the growth patterns of blast cell progenitors (CFU-L) in 23 patients with advanced MDS and 32 patients with de novo AML. Circulating blast progenitors were identified in 74% of MDS and 81% of AML samples. Primary plating efficiencies (PE1) were similar in both disorders, despite marked differences in peripheral blast cell concentrations. By cytological and cytochemical examination, colonies from MDS patients were indistinguishable from those obtained in AML. Cell cycle status was assessed by loss of colony formation following short-term exposure to cytosine arabinoside. CFU-L suicide rates (median, range) were 40% (12% to 77%) in MDS and 60.5% (27% to 98%) in AML. Actively proliferating blast cell progenitors are thus not confined to AML, but are also present in the majority of MDS patients. An important difference between MDS and AML was found when self-renewal capacity of CFU-L was examined by means of secondary plating efficiencies (PE2). Colonies could be successfully replated in 74% of AML cases. PE2 showed marked heterogeneity (2 to 730 colonies/10(5) mononuclear cells), with some values indicating excessive self-renewal capacity of CFU-L. In contrast, 62% of the MDS specimens failed to produce any secondary colony growth, and PE2 in the remaining cases was low (5 to 99/10(5) MNC). We conclude that a different balance between self-renewal and determination could be responsible for a slower pace of clonal expansion in MDS, even if the proliferative activity of clonogenic cells is similar to that in AML.

scholarly journals Comparison of in vitro growth characteristics of blast cell progenitors (CFU-L) in patients with myelodysplastic syndromes and acute myeloid leukemia

Blood ◽  
1992 ◽  
Vol 80 (3) ◽  
pp. 625-633
Author(s):  
C Aul ◽  
N Gattermann ◽  
W Schneider
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Mononuclear Cells ◽  
Current Knowledge ◽  
Blast Cell ◽  
Growth Patterns ◽  
Self Renewal ◽  
Short Term Exposure ◽  
Acute Myeloid

Abstract Current knowledge is inadequate to explain the different patterns of blast cell accumulation in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). We compared the growth patterns of blast cell progenitors (CFU-L) in 23 patients with advanced MDS and 32 patients with de novo AML. Circulating blast progenitors were identified in 74% of MDS and 81% of AML samples. Primary plating efficiencies (PE1) were similar in both disorders, despite marked differences in peripheral blast cell concentrations. By cytological and cytochemical examination, colonies from MDS patients were indistinguishable from those obtained in AML. Cell cycle status was assessed by loss of colony formation following short-term exposure to cytosine arabinoside. CFU-L suicide rates (median, range) were 40% (12% to 77%) in MDS and 60.5% (27% to 98%) in AML. Actively proliferating blast cell progenitors are thus not confined to AML, but are also present in the majority of MDS patients. An important difference between MDS and AML was found when self-renewal capacity of CFU-L was examined by means of secondary plating efficiencies (PE2). Colonies could be successfully replated in 74% of AML cases. PE2 showed marked heterogeneity (2 to 730 colonies/10(5) mononuclear cells), with some values indicating excessive self-renewal capacity of CFU-L. In contrast, 62% of the MDS specimens failed to produce any secondary colony growth, and PE2 in the remaining cases was low (5 to 99/10(5) MNC). We conclude that a different balance between self-renewal and determination could be responsible for a slower pace of clonal expansion in MDS, even if the proliferative activity of clonogenic cells is similar to that in AML.

scholarly journals Acute Myeloid Leukemia and Myelodysplastic Syndromes After Radiation Therapy Are Similar to De Novo Disease and Differ From Other Therapy-Related Myeloid Neoplasms

2012 ◽  
Vol 30 (19) ◽  
pp. 2340-2347 ◽  
Author(s):  
Valentina Nardi ◽  
Karen M. Winkfield ◽  
Chi Young Ok ◽  
Andrzej Niemierko ◽  
Michael J. Kluk ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
De Novo ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Myeloid Neoplasms ◽  
Acute Myeloid

Purpose Therapy-related myeloid neoplasms (t-MN) represent a unique clinical syndrome occurring in patients treated with chemotherapy and/or external-beam radiation (XRT) and are characterized by poorer prognosis compared with de novo disease. XRT techniques have evolved in recent years and are associated with significantly reduced bone marrow exposure. The characteristics of post-XRT t-MN in the current era have not been studied. Patients and Methods We analyzed patients who developed acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) after XRT alone (47 patients) or cytotoxic chemotherapy/combined-modality therapy (C/CMT, 181 patients) and compared them with patients with de novo MDS or AML (222 patients). We estimated bone marrow exposure to radiation and compared the clinical, pathologic, and cytogenetic features and outcome of the XRT patients with the C/CMT patients and with patients with de novo MDS and AML. Results Patients with t-MN after XRT alone had superior overall survival (P = .006) and lower incidence of high-risk karyotypes (P = .01 for AML and < .001 for MDS) compared with patients in the C/CMT group. In contrast, there were no significant differences in survival or frequency of high-risk karyotypes between the XRT and de novo groups. Conclusion AML and MDS diagnosed in the past decade in patients after receiving XRT alone differ from t-MN occurring after C/CMT and share genetic features and clinical behavior with de novo AML/MDS. Our results suggest that post-XRT MDS/AML may not represent a direct consequence of radiation toxicity and warrant a therapeutic approach similar to de novo disease.

scholarly journals Altered Spatial Composition of the Immune Cell Repertoire in Association to CD34+ Blasts in Myelodysplastic Syndromes and Secondary Acute Myeloid Leukemia

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 186
Author(s):  
Marcus Bauer ◽  
Christoforos Vaxevanis ◽  
Haifa Kathrin Al-Ali ◽  
Nadja Jaekel ◽  
Christin Le Hoa Naumann ◽  
...  
Keyword(s):  
T Cells ◽  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Multispectral Imaging ◽  
Immune Cell ◽  
Genetic Alterations ◽  
Spatial Proximity ◽  
Secondary Acute Myeloid Leukemia ◽  
Acute Myeloid

Background: Myelodysplastic syndromes (MDS) are caused by a stem cell failure and often include a dysfunction of the immune system. However, the relationship between spatial immune cell distribution within the bone marrow (BM), in relation to genetic features and the course of disease has not been analyzed in detail. Methods: Histotopography of immune cell subpopulations and their spatial distribution to CD34+ hematopoietic cells was determined by multispectral imaging (MSI) in 147 BM biopsies (BMB) from patients with MDS, secondary acute myeloid leukemia (sAML), and controls. Results: In MDS and sAML samples, a high inter-tumoral immune cell heterogeneity in spatial proximity to CD34+ blasts was found that was independent of genetic alterations, but correlated to blast counts. In controls, no CD8+ and FOXP3+ T cells and only single MUM1p+ B/plasma cells were detected in an area of ≤10 μm to CD34+ HSPC. Conclusions: CD8+ and FOXP3+ T cells are regularly seen in the 10 μm area around CD34+ blasts in MDS/sAML regardless of the course of the disease but lack in the surrounding of CD34+ HSPC in control samples. In addition, the frequencies of immune cell subsets in MDS and sAML BMB differ when compared to control BMB providing novel insights in immune deregulation.

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