Hitoshi Nakagawa

International prognostic scoring system and TP53 mutations are independent prognostic indicators for patients with myelodysplastic syndrome

We applied the International Prognostic Scoring System (IPSS) to our series of 118 patients with myelodysplastic syndrome (MDS) to determine its validity, and also used univariate and multivariate analyses to evaluate the prognostic significance of TP53 configurations. Sixteen patients with the mutation had a strikingly worse prognosis and the multivariate analysis demonstrated that this alteration was the most significant factor. The prognostic comparison between patients with and without the mutation within each IPSS subgroup showed a significant difference in the intermediate subgroups. A combination of clinical manifestations and genetic configurations provided us with more accurate prognostic information in MDS patients.

Assignment of the human granulocyte colony-stimulating factor receptor gene (CSF3R) to chromosome 1 at region p35–p34.3

The gene for the granulocyte colony-stimulating factor (G-CSF) receptor (CSF3R) was localized on the p35-p34.3 region of human chromosome 1 by in situ hybridization using human G-CSF receptor cDNA as the probe. Polymerase chain reaction using oligonucleotides specific for the human CSF3R produced a specifically amplified DNA fragment with DNA from mouse A9 cells that contained human chromosome 1 but not other human chromosomes. Localization of the CSF3R on chromosome 1 was further confirmed by the spot-blot hybridization of sorted human chromosomes.

Feasibility of Reduced-Intensity Cord Blood Transplantation as Salvage Therapy for Graft Failure: Results of a Nationwide Survey of Adult Patients

To evaluate whether rescue with cord blood transplantation (CBT) could improve the poor survival after graft failure (GF), we surveyed the data of 80 adult patients (median age, 51 years) who received CBT within 3 months of GF (primary 64, secondary 16), with fludarabine-based reduced-intensity regimens with or without melphalan, busulfan, cyclophosphamide, and/or 2-4 Gy total-body irradiation (TBI). A median number of 2.4 × 10(7)/kg total nucleated cells (TNC) were infused, and among the 61 evaluable patients who survived for more than 28 days, 45 (74%) engrafted. The median follow-up of surviving patients was 325 days, and the 1-year overall survival rate was 33% despite poor performance status (2-4, 60%), carryover organ toxicities (grade 3/4, 14%), and infections (82%) prior to CBT. Day 100 transplantation-related mortality was 45%, with 60% related to infectious complications. Multivariate analysis showed that the infusion of TNC ≥2.5 × 10(7)/kg and an alkylating agent-containing regimen were associated with a higher probability of engraftment, and that high risk-status at the preceding transplantation and grade 3/4 organ toxicities before CBT were associated with an increased risk of mortality. In conclusion, in an older population of patients, our data support the feasibility of CBT with a reduced-intensity conditioning regimen for GF.

Prognostic significance of loss of a chromosome 17p and p53 gene mutations in blast crisis of chronic myelogenous leukaemia

SUMMARY. In 31 cases of chronic myelogenous leukaemia (CML) we examined the prognostic significance of chromosomal loss of a 17p and p53 mutations at the onset of blast crisis (BC). p53 mutations were closely related to a shortened survival in CMLBC (P < 0.005 by the logrank test), whereas loss of a 17p by itself was not a poor prognostic indicator. The prognostic significance of loss of a 17p, however, emerged when combined with its predominance in the metaphases analysed. This predominance might easily and rapidly be screened by polymerase chain reaction‐based analysis in about half of the cases.

Significance of chromosomal alterations and mutations of the N-RAS and TP53 genes in relation to leukemogenesis of acute myeloid leukemia

We examined chromosomes and mutations of the N-RAS and TP53 genes in 73 patients with acute myeloid leukemia (AML). Twenty-six patients showed a reciprocal chromosomal translocation or an inversion, and 34 patients showed only unbalanced aberrations. Balanced aberrations were predominantly detected in the AML patients who did not have myelodysplasia, preceding myelodysplastic syndrome, and a history of chemotherapy or radiation therapy. In contrast, unbalanced aberrations were more frequently seen in the patients with AML with trilineage myelodysplasia, AML transformed from MDS, and therapy-related AML. Twenty-two mutations of the N-RAS and TP53 genes were detected, and these mutations were frequently associated with unbalanced chromosomal aberrations. Furthermore, the spectrum of mutations was suggestive of an exposure to alkylating chemicals.

Detection of NOTCH1 mutations in adult T-cell leukemia/lymphoma and peripheral T-cell lymphoma.

We analyzedNOTCH1 gene mutation in 53 adults with mature T-cell leukemia/lymphoma: 21 patients with adult T-cell leukemia (ATL), 25 with T-cell non-Hodgkin’s lymphoma (T-NHL), and 7 with T-cell prolymphocytic leukemia. We detected a nonsense mutation, C7249T (resulting in Q2417X, where X is a termination codon) in the PEST domain ofNOTCH1 in an ATL patient and detected a 3-bp deletion (positions 7234-7236) that resulted in deletion of a proline codon at codon 2412 in the PEST domain ofNOTCH1 in a patient with a T-NHL, peripheral T-cell lymphoma-unspecified (PTCL-u). We also analyzed the expression ofNOTCH1 target genes(HES1, CCND1, andMYC), all of which were expressed in the sample of the PTCL-u patient with theNOTCH1 mutation, but found onlyMYC to be expressed in the sample from the ATL patient. These findings suggest that nonsense mutation in the PEST domain in the ATL case was associated with NOTCH1 signaling through a pathway different from that for T-cell acute lymphoblastic leukemia (T-ALL). AlthoughNOTCH1 mutation occurs infrequently in mature T-cell leukemia/lymphoma,NOTCH1 may be involved in leukemogenesis associated with various forms of T-cell leukemia/lymphoma rather than only with T-ALL.

Long Arm Deletion of Chromosome 7 Unrelated to Original Karyotype in Recurrent t(8;21) Acute Myeloblastic Leukemia

We describe a chromosomal abnormality, 7q-, unrelated to the original karyotype in a patient with recurrent t(8;21) acute myeloblastic leukemia. The 7q-, del(7)(q22q34), was seen in otherwise karyotypically normal cells. Cyclophosphamide was administered for 5 months during the maintenance therapy. Our observations indicate that unrelated karyotypes, besides karyotypic evolution, may be implicated in tumor cell heterogeneity and may support the previous documentation of a possibly causal relationship between chemotherapy and development of 7q-. A larger study will be required to elucidate the biologic significance, if any, of the unrelated karyotypes.

Characterization of a 14q+ marker chromosome in philadelphia chromosome positive acute lymphoblastic leukemia by DNA analysis and fluorescence in situ hybridization.

We report a case of precursor-B acute lymphoblastic leukemia (ALL) with the Philadelphia chromosome (Ph) and a 14q+ chromosome whose additional material was a part of the long arm of der(9)t(9;22). A minor population carrying the standard Ph translocation without the 14q+ was also observed at the first presentation. The translocation of the BCR gene from chromosome 22 to the subtelomeric region of the 14q+ was confirmed by fluorescence in situ hybridization (FISH) using a yeast artificial chromosome (YAC) clone containing the BCR gene. The breakpoint of chromosome 14 could not be determined exactly but probably was at 14q24 or 14q32 by conventional chromosome analysis. Nevertheless, FISH using a YAC clone containing the human immunoglobulin heavy chain (IgH) gene locus, Southern blot, and pulsed-field gel electrophoresis (PFGE) analyses with IgJH probe, and loss of heterozygosity analysis at the alpha 1-antitrypsin (AT) gene locus showed lack of involvement of the IgH gene in the 14q+ and more centromeric breakage than the alpha 1-AT locus at 14q32.1. Thus, the formation of the 14q+ seemed to be a secondary genetic event after the Ph translocation and presumably played a minor role in the pathogenesis of B-cell malignancy in this case.