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    Splicing modifications, genomic instability, and hypomethylation are central mechanisms promoting myelodysplasia and acute myeloid leukemia (AML). In this real-life retrospective study, to elucidate pathophysiology of clonal hemopoiesis in hematological malignancies, we investigated clinical significance of mutations in leukemia-related genes of known pathogenetic significance and of variants of uncertain clinical significance (VUS) in a cohort of patients with MDS and AML.A total of 59 consecutive subjects diagnosed with MDS, 48 with AML, and 17 with clonal cytopenia with unknown significance were screened for somatic mutations in AML-related genes by next-generation sequencing.We showed that TET2, SETBP1, ASXL1, EZH2, RUNX1, SRSF2, DNMT3A, and IDH1/2 were commonly mutated. MDS patients also showed a high genetic complexity, especially for SETBP1. Moreover, the presence of SETBP1 wild-type or two or more simultaneous VUS variants identified a subgroup of AML and MDS patients with better outcome, while the presence of single SETBP1 VUS variant was related to a worse prognosis, regardless TET2 mutational status.In conclusions, we linked both pathogenic and VUS variants in AML-related genes to clonal hematopoiesis; therefore, we proposed to consider those variants as prognostic markers in leukemia and myelodysplasia. However, further studies in larger prospective cohorts are required to validate our results.© 2023 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.


    Valentina Giudice, Bianca Serio, Santa Errichiello, Idalucia Ferrara, Alessandra Galdiero, Angela Bertolini, Roberta Visconti, Danilo De Novellis, Roberto Guariglia, Serena Luponio, Denise Morini, Anna Maria Della Corte, Anna Maria Sessa, Francesco Verdesca, Maddalena Langella, Barbara Izzo, Carmine Selleri. Subclones with variants of uncertain clinical significance might contribute to ineffective hemopoiesis and leukemia predisposition. European journal of haematology. 2023 Jul 27

    PMID: 37501402

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