Clonal evolution in myelodysplastic syndromes.

Clonal evolution in myelodysplastic syndromes.
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DOI:
10.1038/ncomms15099
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发表时间:
2017-04-21
影响因子:
16.6
通讯作者:
Jansen JH
Jansen JH
中科院分区:
综合性期刊1区
文献类型:
--
作者:
da Silva-Coelho P;Kroeze LI;Yoshida K;Koorenhof-Scheele TN;Knops R;van de Locht LT;de Graaf AO;Massop M;Sandmann S;Dugas M;Stevens-Kroef MJ;Cermak J;Shiraishi Y;Chiba K;Tanaka H;Miyano S;de Witte T;Blijlevens NMA;Muus P;Huls G;van der Reijden BA;Ogawa S;Jansen JH

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癌症的发展是一个动态的过程,在此过程中,突变的连续积累导致细胞具有越来越多的恶性特征。在这里,我们展示了接受支持治疗的骨髓增生异常综合征(MDS)患者的克隆进化模式,使用或不使用来那度胺(随访2.5-11年)。在疾病过程中多个时间点的全外显子组和靶向深度测序显示,线性和分支进化模式在有或没有疾病修饰治疗的情况下都会发生。疾病修饰疗法的应用可能造成进化瓶颈,之后可能出现更复杂的MDS,但也可能出现不相关的造血细胞克隆。此外,获得与治疗耐药(TP53)或疾病进展(NRAS, KRAS)相关的额外突变的亚克隆可能在临床变化变得明显之前几个月被检测到。在疾病期间监测遗传景观可能有助于指导治疗决策。骨髓增生异常综合征是一组广泛的造血恶性肿瘤,通常进展为急性髓性白血病。在这里,作者表明线性和分支进化发生在骨髓增生异常综合征中,这些模式可以受到治疗的影响。
Cancer development is a dynamic process during which the successive accumulation of mutations results in cells with increasingly malignant characteristics. Here, we show the clonal evolution pattern in myelodysplastic syndrome (MDS) patients receiving supportive care, with or without lenalidomide (follow-up 2.5–11 years). Whole-exome and targeted deep sequencing at multiple time points during the disease course reveals that both linear and branched evolutionary patterns occur with and without disease-modifying treatment. The application of disease-modifying therapy may create an evolutionary bottleneck after which more complex MDS, but also unrelated clones of haematopoietic cells, may emerge. In addition, subclones that acquired an additional mutation associated with treatment resistance (TP53) or disease progression (NRAS, KRAS) may be detected months before clinical changes become apparent. Monitoring the genetic landscape during the disease may help to guide treatment decisions. Myelodysplastic syndromes are a broad group of haematopoietic malignancies that often progress to acute myeloid leukaemia. Here, the authors show that linear and branched evolution occurs within myelodysplastic syndrome and these patterns can be impacted by treatment.
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