Genomic profiling of a randomized trial of interferon-α vs hydroxyurea in MPN reveals mutation-specific responses
Trine Alma Knudsen, Vibe Skov, Kristen Stevenson, Lillian Werner, William Duke, Charles Laurore, Christopher J Gibson, Anwesha Nag, Aaron R Thorner, Bruce Wollison, Dennis Lund Hansen, Christina Ellervik, Daniel El Fassi, Karin de Stricker, Lukas Frans Ocias, Mette Brabrand, Ole Weis Bjerrum, Ulrik Malthe Overgaard, Mikael Frederiksen, Thomas Kielsgaard Kristensen, Torben A Kruse, Mads Thomassen, Torben Mourits-Andersen, Marianne Tang Severinsen, Jesper Stentoft, Joern Starklint, Donna S Neuberg, Lasse Kjaer, Thomas Stauffer Larsen, Hans Carl Hasselbalch, R Coleman Lindsley, Ann Mullally, Trine Alma Knudsen, Vibe Skov, Kristen Stevenson, Lillian Werner, William Duke, Charles Laurore, Christopher J Gibson, Anwesha Nag, Aaron R Thorner, Bruce Wollison, Dennis Lund Hansen, Christina Ellervik, Daniel El Fassi, Karin de Stricker, Lukas Frans Ocias, Mette Brabrand, Ole Weis Bjerrum, Ulrik Malthe Overgaard, Mikael Frederiksen, Thomas Kielsgaard Kristensen, Torben A Kruse, Mads Thomassen, Torben Mourits-Andersen, Marianne Tang Severinsen, Jesper Stentoft, Joern Starklint, Donna S Neuberg, Lasse Kjaer, Thomas Stauffer Larsen, Hans Carl Hasselbalch, R Coleman Lindsley, Ann Mullally
Abstract
Although somatic mutations influence the pathogenesis, phenotype, and outcome of myeloproliferative neoplasms (MPNs), little is known about their impact on molecular response to cytoreductive treatment. We performed targeted next-generation sequencing (NGS) on 202 pretreatment samples obtained from patients with MPN enrolled in the DALIAH trial (A Study of Low Dose Interferon Alpha Versus Hydroxyurea in Treatment of Chronic Myeloid Neoplasms; #NCT01387763), a randomized controlled phase 3 clinical trial, and 135 samples obtained after 24 months of therapy with recombinant interferon-alpha (IFNα) or hydroxyurea. The primary aim was to evaluate the association between complete clinicohematologic response (CHR) at 24 months and molecular response through sequential assessment of 120 genes using NGS. Among JAK2-mutated patients treated with IFNα, those with CHR had a greater reduction in the JAK2 variant allele frequency (median, 0.29 to 0.07; P < .0001) compared with those not achieving CHR (median, 0.27 to 0.14; P < .0001). In contrast, the CALR variant allele frequency did not significantly decline in those achieving CHR or in those not achieving CHR. Treatment-emergent mutations in DNMT3A were observed more commonly in patients treated with IFNα compared with hydroxyurea (P = .04). Furthermore, treatment-emergent DNMT3A mutations were significantly enriched in IFNα-treated patients not attaining CHR (P = .02). A mutation in TET2, DNMT3A, or ASXL1 was significantly associated with prior stroke (age-adjusted odds ratio, 5.29; 95% confidence interval, 1.59-17.54; P = .007), as was a mutation in TET2 alone (age-adjusted odds ratio, 3.03; 95% confidence interval, 1.03-9.01; P = .044). At 24 months, we found mutation-specific response patterns to IFNα: (1) JAK2- and CALR-mutated MPN exhibited distinct molecular responses; and (2) DNMT3A-mutated clones/subclones emerged on treatment.
© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.
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References
- Dameshek W. Some speculations on the myeloproliferative syndromes. Blood. 1951;6(4):372-375.
- Arber DA, Orazi A, Hasserjian R, et al. . The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391-2405.
- Hultcrantz M, Kristinsson SY, Andersson TML, et al. . Patterns of survival among patients with myeloproliferative neoplasms diagnosed in Sweden from 1973 to 2008: a population-based study. J Clin Oncol. 2012;30(24):2995-3001.
- Kaifie A, Kirschner M, Wolf D, et al. ; Study Alliance Leukemia (SAL) . Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry. J Hematol Oncol. 2016;9(1):18.
- Hulegårdh E, Nilsson C, Lazarevic V, et al. . Characterization and prognostic features of secondary acute myeloid leukemia in a population-based setting: a report from the Swedish Acute Leukemia Registry. Am J Hematol. 2015;90(3):208-214.
- Mead AJ, Mullally A. Myeloproliferative neoplasm stem cells. Blood. 2017;129(12):1607-1616.
- Marneth AE, Mullally A. The molecular genetics of myeloproliferative neoplasms. Cold Spring Harb Perspect Med. 2020;10(2):a034876.
- Baxter EJ, Scott LM, Campbell PJ, et al. ; Cancer Genome Project . Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005;365(9464):1054-1061.
- James C, Ugo V, Le Couédic JP, et al. . A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature. 2005;434(7037):1144-1148.
- Kralovics R, Passamonti F, Buser AS, et al. . A gain-of-function mutation of JAK2 in myeloproliferative disorders. N Engl J Med. 2005;352(17):1779-1790.
- Levine RL, Wadleigh M, Cools J, et al. . Activating mutation in the tyrosine kinase JAK2 in polycythemia vera, essential thrombocythemia, and myeloid metaplasia with myelofibrosis. Cancer Cell. 2005;7(4):387-397.
- Scott LM, Tong W, Levine RL, et al. . JAK2 exon 12 mutations in polycythemia vera and idiopathic erythrocytosis. N Engl J Med. 2007;356(5):459-468.
- Milosevic Feenstra JD, Nivarthi H, Gisslinger H, et al. . Whole-exome sequencing identifies novel MPL and JAK2 mutations in triple-negative myeloproliferative neoplasms. Blood. 2016;127(3):325-332.
- Angona A, Fernández-Rodríguez C, Alvarez-Larrán A, et al. . Molecular characterisation of triple negative essential thrombocythaemia patients by platelet analysis and targeted sequencing. Blood Cancer J. 2016;6(8):e463.
- Skov V. Next generation sequencing in MPNs. Lessons from the past and prospects for use as predictors of prognosis and treatment responses. Cancers (Basel). 2020;12(8):1-38.
- Lundberg P, Karow A, Nienhold R, et al. . Clonal evolution and clinical correlates of somatic mutations in myeloproliferative neoplasms. Blood. 2014; 123(14):2220-2228.
- Grinfeld J, Nangalia J, Baxter EJ, et al. . Classification and personalized prognosis in myeloproliferative neoplasms. N Engl J Med. 2018;379(15): 1416-1430.
- Vannucchi AM, Lasho TL, Guglielmelli P, et al. . Mutations and prognosis in primary myelofibrosis. Leukemia. 2013;27(9):1861-1869.
- Guglielmelli P, Lasho TL, Rotunno G, et al. . The number of prognostically detrimental mutations and prognosis in primary myelofibrosis: an international study of 797 patients. Leukemia. 2014;28(9):1804-1810.
- Tefferi A, Guglielmelli P, Lasho TL, et al. . Mutation-enhanced international prognostic systems for essential thrombocythaemia and polycythaemia vera. Br J Haematol. 2020;189(2):291-302.
- Ortmann CA, Kent DG, Nangalia J, et al. . Effect of mutation order on myeloproliferative neoplasms. N Engl J Med. 2015;372(7):601-612.
- Cortelazzo S, Finazzi G, Ruggeri M, et al. . Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995;332(17):1132-1136.
- Fruchtman SM, Mack K, Kaplan ME, Peterson P, Berk PD, Wasserman LR. From efficacy to safety: a Polycythemia Vera Study group report on hydroxyurea in patients with polycythemia vera. Semin Hematol. 1997;34(1):17-23.
- Harrison CN, Campbell PJ, Buck G, et al. ; United Kingdom Medical Research Council Primary Thrombocythemia 1 Study . Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005;353(1):33-45.
- Spanoudakis E, Bazdiara I, Kotsianidis I, et al. . Hydroxyurea (HU) is effective in reducing JAK2V617F mutated clone size in the peripheral blood of essential thrombocythemia (ET) and polycythemia vera (PV) patients. Ann Hematol. 2009;88(7):629-632.
- Larsen TS, Pallisgaard N, de Stricker K, Møller MB, Hasselbalch HC. Limited efficacy of hydroxyurea in lowering of the JAK2 V617F allele burden. Hematology. 2009;14(1):11-15.
- Antonioli E, Carobbio A, Pieri L, et al. . Hydroxyurea does not appreciably reduce JAK2 V617F allele burden in patients with polycythemia vera or essential thrombocythemia. Haematologica. 2010;95(8):1435-1438.
- Kiladjian J-JJ, Cassinat B, Turlure P, et al. . High molecular response rate of polycythemia vera patients treated with pegylated interferon α-2a. Blood. 2006;108(6):2037-2040.
- Quintás-Cardama A, Kantarjian H, Manshouri T, et al. . Pegylated interferon alfa-2a yields high rates of hematologic and molecular response in patients with advanced essential thrombocythemia and polycythemia vera. J Clin Oncol. 2009;27(32):5418-5424.
- Gisslinger H, Klade C, Georgiev P, et al. ; PROUD-PV Study Group . Ropeginterferon alfa-2b versus standard therapy for polycythaemia vera (PROUD-PV and CONTINUATION-PV): a randomised, non-inferiority, phase 3 trial and its extension study. Lancet Haematol. 2020;7(3):e196-e208.
- Kiladjian JJ, Cassinat B, Chevret S, et al. . Pegylated interferon-alfa-2a induces complete hematologic and molecular responses with low toxicity in polycythemia vera. Blood. 2008;112(8):3065-3072.
- Masarova L, Patel KP, Newberry KJ, et al. . Pegylated interferon alfa-2a in patients with essential thrombocythaemia or polycythaemia vera: a post-hoc, median 83 month follow-up of an open-label, phase 2 trial. Lancet Haematol. 2017;4(4):e165-e175.
- Quintás-Cardama A, Abdel-Wahab O, Manshouri T, et al. . Molecular analysis of patients with polycythemia vera or essential thrombocythemia receiving pegylated interferon α-2a. Blood. 2013;122(6):893-901.
- Silver RT. Recombinant interferon-alpha for treatment of polycythaemia vera. Lancet. 1988;2(8607):403.
- Samuelsson J, Hasselbalch H, Bruserud O, et al. ; Nordic Study Group for Myeloproliferative Disorders . A phase II trial of pegylated interferon α-2b therapy for polycythemia vera and essential thrombocythemia: feasibility, clinical and biologic effects, and impact on quality of life. Cancer. 2006; 106(11):2397-2405.
- Stauffer Larsen T, Iversen KF, Hansen E, et al. . Long term molecular responses in a cohort of Danish patients with essential thrombocythemia, polycythemia vera and myelofibrosis treated with recombinant interferon alpha. Leuk Res. 2013;37(9):1041-1045.
- Utke Rank C, Weis Bjerrum O, Larsen TS, et al. . Minimal residual disease after long-term interferon-alpha2 treatment: a report on hematological, molecular and histomorphological response patterns in 10 patients with essential thrombocythemia and polycythemia vera. Leuk Lymphoma. 2016; 57(2):348-354.
- Larsen TS, Bjerrum OW, Pallisgaard N, Andersen MT, Møller MB, Hasselbalch HC. Sustained major molecular response on interferon alpha-2b in two patients with polycythemia vera. Ann Hematol. 2008;87(10):847-850.
- Larsen TS, Møller MB, De Stricker K, et al. . Minimal residual disease and normalization of the bone marrow after long-term treatment with alpha-interferon2b in polycythemia vera. A report on molecular response patterns in seven patients in sustained complete hematological remission. Hematology. 2009;14(6):331-334.
- Swerdlow S, Campo E, Harris N, et al. . World Classification of Tumors of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC; 2008
- Barosi G, Mesa R, Finazzi G, et al. . Revised response criteria for polycythemia vera and essential thrombocythemia: an ELN and IWG-MRT consensus project. Blood. 2013;121(23):4778-4781.
- Barosi G, Bordessoule D, Briere J, et al. ; European Myelofibrosis Network . Response criteria for myelofibrosis with myeloid metaplasia: results of an initiative of the European Myelofibrosis Network (EUMNET). Blood. 2005;106(8):2849-2853.
- Segura-Díaz A, Stuckey R, Florido Y, et al. . Thrombotic risk detection in patients with polycythemia vera: the predictive role of DNMT3A/TET2/ASXL1 mutations. Cancers (Basel). 2020;12(4):1-9.
- Tefferi A, Lasho TL, Guglielmelli P, et al. . Targeted deep sequencing in polycythemia vera and essential thrombocythemia. Blood Adv. 2016;1(1):21-30.
- Cerquozzi S, Barraco D, Lasho T, et al. . Risk factors for arterial versus venous thrombosis in polycythemia vera: a single center experience in 587 patients. Blood Cancer J. 2017;7(12):662.
- Mosca M, Lamrani L, Marzac C, et al. . Differential impact of interferon alpha on JAK2V617F and CALR mutated hematopoietic stem and progenitor cells in classical MPN. Blood. 2018;132(suppl 1):4333.
- Mascarenhas J, Kosiorek HE, Prchal JT, et al. . Results of the Myeloproliferative Neoplasms–Research Consortium (MPN-RC) 112 randomized trial of pegylated interferon alfa-2a (PEG) versus hydroxyurea (HU) therapy for the treatment of high risk polycythemia vera (PV) and high risk essential thrombocythemia. Blood. 2018;132(suppl 1):577.
- Kjær L, Cordua S, Holmström MO, et al. . Differential dynamics of CALR mutant allele burden in myeloproliferative neoplasms during interferon alfa treatment. PLoS One. 2016;11(10):e0165336.
- Verger E, Cassinat B, Chauveau A, et al. . Clinical and molecular response to interferon-α therapy in essential thrombocythemia patients with CALR mutations. Blood. 2015;126(24):2585-2591.
- Czech J, Cordua S, Weinbergerova B, et al. . JAK2V617F but not CALR mutations confer increased molecular responses to interferon-α via JAK1/STAT1 activation. Leukemia. 2019;33(4):995-1010.
- Jia R, Kralovics R. Progress in elucidation of molecular pathophysiology of myeloproliferative neoplasms and its application to therapeutic decisions. Int J Hematol. 2020;111(2):182-191.
- Nangalia J, Nice FL, Wedge DC, et al. . DNMT3A mutations occur early or late in patients with myeloproliferative neoplasms and mutation order influences phenotype. Haematologica. 2015;100(11):e438-e442.
- Rao N, Butcher CM, Lewis ID, et al. . Clonal and lineage analysis of somatic DNMT3A and JAK2 mutations in a chronic phase polycythemia vera patient. Br J Haematol. 2012;156(2):268-270.
- Young AL, Challen GA, Birmann BM, Druley TE. Clonal haematopoiesis harbouring AML-associated mutations is ubiquitous in healthy adults. Nat Commun. 2016;7(1):12484.
- Stetka J, Hansen N, Kubovcakova L, Hao-shen H, Dirnhofer S, Skoda RC. Loss of Dnmt3a confers resistance to pegifn α in JAK2-V617F mouse model [abstract]. Blood. 2020;136(Supplement 1):8-9. Abstract 635.
- Jacquelin S, Straube J, Cooper L, et al. . Jak2V617F and Dnmt3a loss cooperate to induce myelofibrosis through activated enhancer-driven inflammation. Blood. 2018;132(26):2707-2721.
- Skoda RC. Accelerating myelofibrosis through loss of Dnmt3a. Blood. 2018;132(26):2703-2704.
- Lindsley RC, Saber W, Mar BG, et al. . Prognostic mutations in myelodysplastic syndrome after stem-cell transplantation. N Engl J Med. 2017;376(6):536-547.
- Gibson CJ, Lindsley RC, Tchekmedyian V, et al. . Clonal hematopoiesis associated with adverse outcomes after autologous stem-cell transplantation for lymphoma. J Clin Oncol. 2017;35(14):1598-1605.
- Kahn JD, Miller PG, Silver AJ, et al. . PPM1D-truncating mutations confer resistance to chemotherapy and sensitivity to PPM1D inhibition in hematopoietic cells. Blood. 2018;132(11):1095-1105.
- Hsu JI, Dayaram T, Tovy A, et al. . PPM1D mutations drive clonal hematopoiesis in response to cytotoxic chemotherapy. Cell Stem Cell. 2018;23(5):700-713.e6.
- Kubesova B, Pavlova S, Malcikova J, et al. . Low-burden TP53 mutations in chronic phase of myeloproliferative neoplasms: association with age, hydroxyurea administration, disease type and JAK2 mutational status. Leukemia. 2018;32(2):450-461.
- Gisslinger H, Klade C, Georgiev P, et al. . Long-term use of ropeginterferon alpha-2b in polycythemia vera: 5-year results from a randomized controlled study and its extension [abstract]. Blood. 2020;136(supplement 1):33. Abstract 481.
- Gisslinger H, Klade C, Georgiev P, et al. . Ropeginterferon alfa-2b: efficacy and safety in different age groups. HemaSphere. 2020;4(6):e485.
- Van Egeren D, Escabi J, Nguyen M, et al. . Reconstructing the lineage histories and differentiation trajectories of individual cancer cells in myeloproliferative neoplasms. Cell Stem Cell. 2021;28(3):514-523.e9.
- Williams N, Lee J, Moore L, et al. . Phylogenetic reconstruction of myeloproliferative neoplasm reveals very early origins and lifelong evolution. bioRxiv. Posted online November 9, 2020.
- Jaiswal S, Natarajan P, Silver AJ, et al. . Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. N Engl J Med. 2017;377(2):111-121.
- Cordua S, Kjaer L, Skov V, Pallisgaard N, Hasselbalch HC, Ellervik C. Prevalence and phenotypes of JAK2 V617F and calreticulin mutations in a Danish general population. Blood. 2019;134(5):469-479.
- Wolach O, Sellar RS, Martinod K, et al. . Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms. Sci Transl Med. 2018;10(436):eaan8292.
- Pedersen RK, Andersen M, Knudsen TA, et al. . Data-driven analysis of JAK2 V617F kinetics during interferon- alpha2 treatment of patients with polycythemia vera and related neoplasms. Cancer Med. 2020;9(6):2039-2051.
- Steensma DP, Bolton KL. What to tell your patient with clonal hematopoiesis and why: insights from 2 specialized clinics. Blood. 2020;136(14): 1623-1631.
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