Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany.
Ann Hematol. 2022 Dec;101(12):2655-2663. doi: 10.1007/s00277-022-05000-9. Epub 2022 Oct 21.
Molecular diagnostics moves more into focus as technology advances. In patients with myeloproliferative neoplasms (MPN), identification and monitoring of the driver mutations have become an integral part of diagnosis and monitoring of the disease. In some patients, none of the known driver mutations (JAK2V617F, CALR, MPL) is found, and they are termed "triple negative" (TN). Also, whole-blood variant allele frequency (VAF) of driver mutations may not adequately reflect the VAF in the stem cells driving the disease. We reasoned that colony forming unit (CFU) assay-derived clonogenic cells may be better suited than next-generation sequencing (NGS) of whole blood to detect driver mutations in TN patients and to provide a VAF of disease-driving cells. We have included 59 patients carrying the most common driver mutations in the establishment or our model. Interestingly, cloning efficiency correlated with whole blood VAF (p = 0.0048), suggesting that the number of disease-driving cells correlated with VAF. Furthermore, the clonogenic VAF correlated significantly with the NGS VAF (p < 0.0001). This correlation was lost in patients with an NGS VAF <15%. Further analysis showed that in patients with a VAF <15% by NGS, clonogenic VAF was higher than NGS VAF (p = 0.003), suggesting an enrichment of low numbers of disease-driving cells in CFU assays. However, our approach did not enhance the identification of driver mutations in 5 TN patients. A significant correlation of lactate dehydrogenase (LDH) serum levels with both CFU- and NGS-derived VAF was found. Our results demonstrate that enrichment for clonogenic cells can improve the detection of MPN driver mutations in patients with low VAF and that LDH levels correlate with VAF.
随着技术的进步,分子诊断越来越受到关注。在骨髓增殖性肿瘤(MPN)患者中,驱动突变的鉴定和监测已成为诊断和监测疾病的重要组成部分。在一些患者中,未发现任何已知的驱动突变(JAK2V617F、CALR、MPL),这些患者被称为“三阴性”(TN)。此外,驱动突变的全血变异等位基因频率(VAF)可能无法充分反映驱动疾病的干细胞中的 VAF。我们推断,集落形成单位(CFU)测定衍生的克隆形成细胞可能比全血下一代测序(NGS)更适合于检测 TN 患者中的驱动突变,并提供疾病驱动细胞的 VAF。我们已经纳入了 59 名携带最常见驱动突变的患者来建立我们的模型。有趣的是,克隆效率与全血 VAF 相关(p=0.0048),表明疾病驱动细胞的数量与 VAF 相关。此外,克隆形成 VAF 与 NGS VAF 显著相关(p<0.0001)。在 NGS VAF<15%的患者中,这种相关性丢失。进一步分析表明,在 NGS VAF<15%的患者中,克隆形成 VAF 高于 NGS VAF(p=0.003),表明 CFU 测定中疾病驱动细胞的数量较低。然而,我们的方法并没有提高 5 名 TN 患者中驱动突变的识别率。发现乳酸脱氢酶(LDH)血清水平与 CFU 和 NGS 衍生的 VAF 均显著相关。我们的结果表明,在 VAF 较低的患者中,克隆形成细胞的富集可以提高 MPN 驱动突变的检测率,并且 LDH 水平与 VAF 相关。