1. Genomic profiling and directed ex vivo drug analysis of an unclassifiable myelodysplastic/myeloproliferative neoplasm progressing into acute myeloid leukemia.
- Author
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Hyrenius-Wittsten A, Sturesson H, Bidgoli M, Jonson T, Ehinger M, Lilljebjörn H, Scheding S, and Andersson AK
- Subjects
- Adult, Bortezomib administration & dosage, DNA Methyltransferase 3A, Disease Progression, Female, Gene Duplication, Gene Frequency, Genetic Heterogeneity, Genome, Human, Humans, Leukemia, Myeloid, Acute genetics, Leukemia, Myeloid, Acute pathology, Mutation, Myelodysplastic Syndromes genetics, Myelodysplastic Syndromes pathology, Pyridones administration & dosage, Pyrimidinones administration & dosage, DNA (Cytosine-5-)-Methyltransferases genetics, GTP Phosphohydrolases genetics, Histone-Lysine N-Methyltransferase genetics, Leukemia, Myeloid, Acute drug therapy, Membrane Proteins genetics, Myelodysplastic Syndromes drug therapy, Myeloid-Lymphoid Leukemia Protein genetics
- Abstract
Myelodysplastic/myeloproliferative neoplasms, unclassifiable (MDS/MPN-U) are rare genetically heterogeneous hematologic diseases associated with older age and a poor prognosis. If the disease progresses into acute myeloid leukemia (AML), it is often refractory to treatment. To gain insight into genetic alterations associated with disease progression, whole exome sequencing and single nucleotide polymorphism arrays were used to characterize the bone marrow and blood samples from a 39-year-old woman at MDS/MPN-U diagnosis and at AML progression, in which routine genetic diagnostics had not identified any genetic alterations. The data revealed the presence of a partial tandem duplication of the MLL gene as the only detectable copy number change and 11 non-silent somatic mutations, including DNMT3A R882H and NRAS G13D. All somatic lesions were present both at initial MDS/MPN-U diagnosis and at AML presentation at similar mutant allele frequencies. The patient has since had two extramedullary relapses and is at high risk of a future bone marrow relapse. A directed ex vivo drug sensitivity analysis showed that the patient's AML cells are sensitive to, for example, the MEK inhibitor trametinib and the proteasome inhibitor bortezomib, indicating that she may benefit from treatment with these drugs. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
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