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Integrated flow cytometry and sequencing to reconstruct evolutionary patterns from dysplasia to acute myeloid leukemia

Autores: Simoes Pinto, Cátia Patricia; Chillón, M. C.; Martínez-Cuadrón, D.; Calasanz Abinzano, María José; Vridiales, M. B.; Vázquez Urio, Iria; Hernández-Ruano, M.; Ariceta Ganuza, Beñat; Aguirre-Ruiz, P.; Burgos Rodríguez, Leire; Alignani, Diego Oscar; Sarvide Plano, Sarai; Villar Fernández, Sara; Pierola, A. A.; Prosper Cardoso, Felipe; Ayala, R.; Martínez-López, J.; Bergua-Burgues, J. M.; Vives, S.; Pérez-Simón, J. A.; Garcia-Fortes, M.; Bernal del Castillo, T.; Colorado, M.; Olave, M.; Rodríguez-Gutiérrez, J. I.; Labrador, J.; González, M.; San Miguel Izquierdo, Jesús; Sanz, M. A.; Montesinos, P.; Paiva, Bruno (Autor de correspondencia)
Título de la revista: BLOOD ADVANCES
ISSN: 2473-9529
Volumen: 7
Número: 1
Páginas: 167 - 173
Fecha de publicación: 2023
Clonal evolution in acute myeloid leukemia (AML) originates long before diagnosis and is a dynamic process that may affect survival. However, it remains uninvestigated during routine diagnostic workups. We hypothesized that the mutational status of bone marrow dysplastic cells and leukemic blasts, analyzed at the onset of AML using integrated multidimensional flow cytometry (MFC) immunophenotyping and fluorescence-activated cell sorting (FACS) with next-generation sequencing (NGS), could reconstruct leukemogenesis. Dysplastic cells were detected by MFC in 285 of 348 (82%) newly diagnosed patients with AML. Presence of dysplasia according to MFC and World Health Organization criteria had no prognostic value in older adults. NGS of dysplastic cells and blasts isolated at diagnosis identified 3 evolutionary patterns: stable (n= 12 of 21), branching (n= 4 of 21), and clonal evolution (n= 5 of 21). In patients achieving complete response (CR), integrated MFC and FACS with NGS showed persistent measurable residual disease (MRD) in phenotypically normal cell types, as well as the acquisition of genetic traits associated with treatment resistance. Furthermore, whole-exome sequencing of dysplastic and leukemic cells at diagnosis and of MRD uncovered different clonal involvement in dysplastic myelo-erythropoiesis, leukemic transformation, and chemoresistance. Altogether, we showed that it is possible to reconstruct leukemogenesis in 80% of patients with newly diagnosed AML, using techniques other than single-cell multiomics.