Navigating the contested borders between myelodysplastic syndrome and acute myeloid leukemia.

Navigating the contested borders between myelodysplastic syndrome and acute myeloid leukemia.
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DOI:
10.3389/fonc.2022.1033534
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发表时间:
2022
影响因子:
4.7
通讯作者:
--
中科院分区:
医学3区
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--
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骨髓增生异常综合征和急性骨髓性白血病是异质性骨髓肿瘤,其由骨髓干细胞或祖细胞中的突变积累引起,这些突变赋予生存或生长优势。这些疾病过程通过临床、实验室和形态学表现来正式区分,特别是关于外周血或骨髓(AML)中原始细胞的优势;然而,它们通过它们的共同谱系以及它们在谱上的存在与一些MDS病例密切相关,MDS病例显示出增加的原始细胞,这是反映更多AML样行为的特征,以及MDS转化为AML的倾向。人们越来越认识到,这两个实体之间的区别是由驱动它们各自的基因改变的不同模式造成的。与染色质重塑和剪接体相关的基因突变见于MDS和由先前MDS引起的AML中,而与信号传导途径如RAS或FLT 3相关的基因突变更常见于AML中,或者是转化的先兆。在这篇综述中,我们专注于MDS和AML之间的生物学和遗传学差异和相似性的见解,这些差异和相似性现在被用于改进临床诊断,指导疾病管理,并为开发新的治疗方法提供信息。
Myelodysplastic syndrome and acute myeloid leukemia are heterogeneous myeloid neoplasms which arise from the accumulation of mutations in a myeloid stem cell or progenitor that confer survival or growth advantages. These disease processes are formally differentiated by clinical, laboratory, and morphological presentations, especially with regard to the preponderance of blasts in the peripheral blood or bone marrow (AML); however, they are closely associated through their shared lineage as well as their existence on a spectrum with some cases of MDS displaying increased blasts, a feature that reflects more AML-like behavior, and the propensity for MDS to transform into AML. It is increasingly recognized that the distinctions between these two entities result from the divergent patterns of genetic alterations that drive each of them. Mutations in genes related to chromatin-remodeling and the spliceosome are seen in both MDS and AML arising out of antecedent MDS, while mutations in genes related to signaling pathways such as RAS or FLT3 are more typically seen in AML or otherwise are a harbinger of transformation. In this review, we focus on the insights into the biological and genetic distinctions and similarities between MDS and AML that are now used to refine clinical prognostication, guide disease management, and to inform development of novel therapeutic approaches.
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