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Haematologica. 2009 Dec;94(12):1762-6. doi: 10.3324/haematol.2009.011528. Epub 2009 Oct 1.

Clonal heterogeneity in the 5q- syndrome: p53 expressing progenitors prevail during lenalidomide treatment and expand at disease progression.

Author information

1
Karolinska Institutet, Department of Medicine, Center for Experimental Hematology, Karolinska University Hospital, Stockholm, Sweden. martin.jadersten@ki.se

Abstract

Clonal heterogeneity has not been described in patients with myelodysplastic syndrome with isolated del(5q), for which lenalidomide has emerged as a highly potent treatment. However, transformation to acute myeloid leukemia is occasionally observed, particularly in patients without a cytogenetic response to lenalidomide. We performed molecular studies in a patient with classical 5q- syndrome with complete erythroid and partial cytogenetic response to lenalidomide, who evolved to high-risk myelodysplastic syndrome with complex karyotype. Immunohistochemistry of pre-treatment marrow biopsies revealed a small fraction of progenitors with overexpression of p53 and sequencing confirmed a TP53 mutation. TP53 mutated subclones have not previously been described in myelodysplastic syndrome with isolated del(5q) and indicates a previously unknown heterogeneity of this disease. The aberrant subclone remained stable during the treatment with lenalidomide and expanded at transformation, suggesting that this pre-existing cell population had molecular features which made it insensitive to lenalidomide and prone to disease progression.

PMID:
19797731
PMCID:
PMC2791931
DOI:
10.3324/haematol.2009.011528
[Indexed for MEDLINE]
Free PMC Article

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