Results of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Myeloid Leukemia with t(8;21)(q22;q22)/RUNX1-RUNX1T1 and Additional Cytogenetic Abnormalities

TL Gindina, NN Mamaev, SN Bondarenko, ES Nikolaeva, OA Slesarchuk, AS Borovkova, OV Paina, SV Razumova, AL Alyanskii, LS Zubarovskaya, BV Afanas’ev

R.M. Gorbacheva Scientific Research Institute of Pediatric Hematology and Transplantation; Academician I.P. Pavlov First St. Petersburg State Medical University, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022

For correspondence: Tat’yana Leonidovna Gindina, PhD, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022; Tel.: +7(812)233-12-43; e-mail: cytogenetics.bmt.lab@gmail.com

For citation: Gindina TL, Mamaev NN, Bondarenko SN, et al. Results of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Myeloid Leukemia with t(8;21)(q22;q22)/RUNX1-RUNX1T1 and Additional Cytogenetic Abnormalities. Clinical oncohematology. 2016;9(2):148–54 (In Russ).

DOI: 10.21320/2500-2139-2016-9-2-148-154


ABSTRACT

Aim. To evaluate the impact of additional chromosomal aberrations on outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML) with t(8;21)(q22;q22)/RUNX1-RUNX1T1 translocation.

Methods. Twenty-five AML patients with t(8;21)(q22;q22)/RUNX1-RUNX1T1 translocation (10 women and 15 men, aged from 2 to 58 years; median 20.2) were examined. Analysis of overall (OS) and event-free survival (EFS) predictors after allo-HSCT in patients with different clinical, transplant and cytogenetic characteristics was performed.

Results. The additional cytogenetic abnormalities were found in 13 (52 %) patients before the transplantation, at that, complex karyotype with three or more chromosomal abnormalities were registered in 9 (69 %) patients. The univariate analysis showed that OS and EFS after allo-HSCT differed in patients with different characteristics such as age (= 0.03; = 0.0006), clinical status at transplantation (= 0.0002; = 0,006), donor type (= 0.0003; = 0.002), the interval from diagnosis of leukemia to allo-HSCT (= 0,008, for OS only), additional cytogenetic abnormalities (= 0.03; = 0.009) and complex karyotype (= 0.004; = 0.0003), respectively. In multivariate analysis, independent predictors of OS were donor type (= 0.01), the interval from diagnosis of leukemia to allo-HSCT (= 0.01), and additional cytogenetic abnormalities in karyotype (= 0.04), as well as donor type (= 0.04) and patient’s age (= 0.004) for EFS.

Conclusion. AML with t(8;21)(q22;q22)/RUNX1-RUNX1T1 translocation is a heterogeneous disease. The prognosis in patients with the additional cytogenetic abnormalities, especially in those with the complex karyotype, is worse both after the standard chemotherapy (i.e. before allo-HSCT), and after allo-HSCT.


Keywords: AML with t(8;21) translocation, allo-HSCT, cytogenetic abnormalities.

Received: February 6, 2016

Accepted: February 15, 2016

Read in PDF (RUS)pdficon


REFERENCES

  1. Mrozek K, Bloomfield CD. Chromosomal abnormalities in acute leukemia and their clinical importance. In: Rowley JD, et al, eds. Chromosomal translocations and genome rearrangements in cancer. Switzerland: Springer International Publishing; 2015. pp. 275–306. doi: 10.1007/978-3-319-19983-2_13.
  2. Klein K, Kaspers G, Harrison CJ, et al. Clinical impact of additional cytogenetic aberrations, cKIT and RAS mutations, and treatment elements in pediatric t(8;21)-AML: results from an international retrospective study by the international Berlin-Frankfurt-Munster study group. J Clin Oncol. 2015;33(36):4247. doi: 10.1200/jco.2015.61.1947.
  3. Krauth MT, Eder C, Alpermann T, et al. High number of additional genetic lesions in acute myeloid leukemia with t(8;21)/RUNX1-RUNX1T1: frequency and impact on clinical outcome. Leukemia. 2014;28(7):1449–58. doi:10.1038/leu.2014.4.
  4. Byrd JC, Dodge RK, Carroll A, et al. Patients with t(8;21)(q22;q22) and acute myeloid leukemia have superior failure-free and overall survival when repetitive cycles of high-dose cytarabine are administered. J Clin Oncol. 1999;17:3767–75.
  5. Numata A, Fujimaki K, Aoshima T, et al. Retrospective analysis of treatment outcomes in 70 patients with t(8;21) acute myeloid leukemia. Jpn J Clin Oncol. 2012;53(7):698–704.
  6. Kuwatsuka Y, Miyamura K, Suzuki R, et al. Hematopoietic cell transplantation for core binding factor acute myeloid leukemia: t(8;21) and inv(16) represent different clinical outcomes. Blood. 2009;113(9):2096–103. doi: 10.1182/blood-2008-03-145862/
  7. Shlenk RF, Benner A, Krauter J, et al. Individual patient data-based meta-analysis of patients aged 16 to 60 years with core binding factor acute myeloid leukemia: a survey of the German Acute Myeloid Leukemia Intergroup. J Clin Oncol. 2004;22(18):3741–50. doi: 10.1200/JCO.2004.03.012.
  8. Shlenk RF, Pasquini MC, Perez WS, et al. HLA-identical sibling allogeneic transplant versus chemotherapy in acute myelogenous leukemia with t(8;21) in first complete remission: collaborative study between the German AML Intergroup and CIBMTR. Biol Blood Marrow Transplant. 2008;14(2):187–96. doi: 10.1016/j.bbmt.2007.10.006.
  9. Мамаев Н.Н., Горбунова А.В., Гиндина Т.Л. и др. Трансплантация гемопоэтических стволовых клеток при остром миелоидном лейкозе с транслокацией t(8;21)(q22;q22). Клиническая онкогематология. 2013;6(4):439–50.
    [Mamaev NN, Gorbunova AV, Gindina TL, et al. Hematopoietic stem cell transplantation in AML patients with t(8;21) (q22;q22) translocation. Klinicheskaya onkogematologiya. 2013;6(4):439–50. (In Russ)]
  10. Appelbaum FR, Kopecky KJ, Tallman MS, et al. The clinical spectrum of adult acute myeloid leukemia associated with core binding factor translocations. Br J Haematol. 2006;135(2):165–73. doi: 10.1111/j.1365-2141.2006.06276.x.
  11. Yoon JH, Kim HJ, Kim JW, et al. Identification of molecular and cytogenetic risk factors for unfavorable core-binding factor-positive adult AML with post-remission treatment outcome analysis including transplantation. Bone Marrow Transplant. 2014;49(12):1466–74. doi: 10.1038/bmt.2014.180.
  12. Marcucci G, Mrozek K, Ruppert AS, et al. Prognostic factors and outcome of core binding factor acute myeloid leukemia patients with t(8;21) differ from those of patients with inv(16): a Cancer and Leukemia Group B Study. J Clin Oncol. 2005;23(24):5705–17. doi: 10.1200/jco.2005.15.610.
  13. Qin YZ, Zhu HH, Jiang Q, et al. Prevalence and prognostic significance of c-KIT mutations in core binding factor acute myeloid leukemia: a comprehensive large-scale study from a single Chinese center. Leuk Res. 2016;38(12):1435–40. doi: 10.1016/j.leukres.2014.09.017.
  14. Mosna F, Papayannidis C, Martinelli G, et al. Complex karyotype, older age, and reduced first-line dose intensity determine poor survival in core binding factor acute myeloid leukemia patients with long-term follow-up. Am J Hematol. 2015;90(6):515–23. doi: 10.1002/ajh.24000.
  15. Гиндина Т.Л., Мамаев Н.Н., Бархатов И.М. и др. Сложные повреждения хромосом у больных с рецидивами острых лейкозов после аллогенной трансплантации гемопоэтических стволовых клеток. Терапевтический архив. 2012;8:61–6.
    [Gindina TL, Mamaev NN, Barhatov IM, et al. Complex chromosome damages in patients with recurrent acute leukemias after allogeneic hematopoietic stem cell transplantations. Terapevticheskii arkhiv. 2012;8:61–6. (In Russ)]
  16. Schaffer L, McGovan-Jordan J, Schmid M. ISCN. An international System for Human Cytogenetic Nomenclature. Basel: S. Karger; 2013.
  17. Gindina T, Mamaev N, Nikolaeva E, et al. Jumping translocations in a 13-year-old child with RUNX1/RUNX1T1-positive acute myeloid leukemia. 10th European Cytogenetics Conference 2015. Chromosome Res. 2015;23(Suppl 1):88. doi: 10.1007/s10577-015-9476-6.
  18. Мамаев Н.Н., Горбунова А.В., Бархатов И.М. и др. Молекулярный мониторинг течения острых миелоидных лейкозов по уровню экспрессии гена WT1 после аллогенной трансплантации гемопоэтических стволовых клеток. Клиническая онкогематология. 2015;8(3):309–20.
    [Mamaev NN, Gorbunova AV, Barkhatov IM, et al. Molecular Monitoring of WT1 Gene Expression Degree in Acute Myeloid Leukemias after Allogeneic Hematopoietic Stem Cell Transplantation. Klinicheskaya onkogematologiya. 2015;8(3):309–20. (In Russ)]
  19. Mamaev N, Mamaeva S. Two cases of acute myeloblastic leukemia (M2-type) with karyotypes 45X,-X,t(6;8)(q27;q22),inv(9) and 46,XY, t(8;21)(q22;q22),del(9)(q22). Cancer Genet Cytogenet. 1985;18(2):105–11. doi: 10.1016/0165-4608(85)90060-3.

 

Hematopoietic stem cell transplantation in AML patients with t(8;21)(q22;q22) translocation

N.N. Mamayev, A.V. Gorbunova, T.L. Gindina, I.M. Barkhatov, S.N. Bondarenko, M.Yu. Averyanova, О.V. Pirogova, O.V. Goloshchapov, Ye.V. Kondakova, and B.V. Afanasyev

R.M. Gorbacheva Institute of Pediatric Oncology, Hematology and Transplantology, I.P. Pavlov State Medical University, Saint Petersburg, Russian Federation


ABSTRACT

The outcomes of bone marrow transplantation for treatment of relapses in 7 AML patients with t(8;21)(q22;q22) translocation are presented and analyzed. Two of them were transplanted in the 1st remission, and 5 patients received HSCT during resistance to the therapy. Three patients underwent unrelated allo-HSCT with various sources of HSC. Three others were treated with related allo-, auto-, or haplo-HSCT, respectively. In the last patient, auto-HSCT followed by related haplo-HSCT was performed. The course of disease was monitored using the serial levels of both AML1-ETO and WT1 gene expression. The high AML1-ETO levels and t(8;21) translocation were detected in all studied patients, whereas no FLT3 gene mutations were found in any patients, and a classic V617F JAK2 mutation was present in 1 patient. The levels of AML1-ETO and WT1 gene expression decreased in parallel with the relapse reduction in 2 patients, but remained elevated in 3 other patients despite the normalization of bone marrow morphologic picture, including 2 cases of development of extramedullary AML relapses. Relapses were accompanied by the high levels of the above gene expression. The study led to the conclusion that bone marrow transplantation is indicated for some AML patients with t(8;21) translocation. The treatment efficacy can be monitored using serial measurements of WT1 gene expression levels.


Keywords: AML with t(8;21) translocation, bone marrow transplantation, AML1-ETO and WT1 gene expression monitoring, molecular monitoring during treatment of leukemia.

Read in PDF (RUS) pdficon


Refernces

  1. Zander A.R., Bacher U., Finke J. Allogeneic stem cell transplantation in acute myeloid leukemia establishment of indications on the basis of individual risk stratification. Arztebl. Int. 2008; 105(39): 663–9.
  2. Numata A., Fujimaki K., Aoshima T. et al. Retrospective analysis of treatment outcomes in 70 patients with t(8;21) acute myeloid leukemia. Rinsho Ketsueki 2012; 53(7): 698–704.
  3. Kawamura M., Kaku H., Ito T. et al. FLT3-internal tandem duplication in a pediatric patient with t(8;21) acute myeloid leukemia. Cancer Genet. Cytogenet. 2010; 203(2): 292–6.
  4. Chen Y.M., Liu T.F., Ruan M. et al. Prognosis and chromosomal abnormalities in 79 children with t(8;21) acute myeloid leukemia. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2009; 31(5): 542–6.
  5. Mamaev N., Mamaeva S. Two cases of acute myeloblastic leukemia (M2 type) with karyotypes 45X,-X,t(6;8)(q27;q22),inv(9) and 46,XY,t(8;21) (q22;q22),del(9)(q22). Cancer Genet. Cytogenet. 1985; 18(2): 105–11.
  6. Мамаев Н.Н., Горбунова А.В., Гиндина Т.Л. и др. Лейкозы и миело- диспластические синдромы с высокой экспрессией гена EVI1: теоретиче- ские и клинические аспекты. Клин. онкогематол. 2012; 5(4): 361–4. [Mamayev N.N., Gorbunova A.V., Gindina T.L. i dr. Leykozy i miyelodisplasticheskiye sindromy s vysokoy ekspressiyey gena EVI1: teoreticheskiye i klinicheskiye aspekty (Leukemias and myelodisplastic syndromes with high EVI1 gene expression: theoretical and clinical aspects. In: Clin. oncohematol.). Klin. onkogematol. 2012; 5(4): 361–4.]
  7. Forman S.J., Rowe J.M. The myth of the second remission of acute leukemia in the adult. Blood 2013; 121(7): 1077–82.
  8. Kuwatsuka Y., Miyamura K., Suzuki R. et al. Hematopoietic stem cell transplantation for core binding factor acute myeloid leukemia: t(8;21) and inv(16) represent different clinical outcomes. Blood 2009; 113: 2096–103.
  9. Zhao X.S., Jin S., Zhu H.H. et al. Wilms’ tumor gene 1 expression: an independent acute leukemia prognostic indicator following allogeneic hematopoietic SCT. Bone Marrow Transplant. 2012; 47(4): 499–507.
  10. Candoni A., Toffoletti E., Gallina R. et al. Monitoring of minimal residual disease by quantitative WT1 gene expression following reduced intensity conditioning allogeneic stem cell transplantation in acute myeloid leukemia. Clin. Transplant. 2011; 25: 308–16.
  11. Lange T., Hubmann M., Burkhardt R. et al. Monitoring of WT1 expression in PB and CD34+ donor chimerism of BM predicts early relapse in AML and MDS patients after hematopoietic cell transplantation with reduced-intensity conditioning. Leukemia 2011; 25: 498–505.
  12. Kwon M., Martinez-Laperche C., Infante M. et al. Evaluation of minimal residual disease by real-time quantitative PCR of Wilms’ Tumor 1 expression in patients with acute myelogenous leukemia after allogeneic stem cell transplantation: Correlation with flow cytometry and chimerism. Biol. Blood Marrow Transplant. 2012; 18: 1235–42.