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Acute myeloid leukemia (AML) is a blood cancer that in Europe affects approximately 4 persons in every 100,000 individuals every year. In AML patients the normal production of blood cells is impaired and the bone marrow (the site of production of blood cells) fills up with malignant cells, that leave only little or no space to the healthy cells (see image). One of the major treatments for AML patients is chemotherapy followed by bone marrow transplantation. Only patients that are considered fit enough can undergo this treatment, to the others milder alternatives are offered. One of the alternative treatments are hypomethylating agents (HMAs). Approximately 50% of the patients benefit from this treatment and it can take up to 6 months to experience response to the therapy. Early response prediction could save ultimately unresponsive patients from unnecessary treatments.
The researcher Francesca Tiso and pathologist Konnie Hebeda investigated the changes in the bone marrow of AML patients treated with HMAs by hematologist Saskia Langemeijer and colleagues, with the goal of finding possible early correlations with positive response to treatment. The research group, led by professor Joop Jansen from the Department of Laboratory Medicine – Lab of Hematology, in collaboration with the Departments of Pathology published the results in Pathobiology on the 20th of April 2024.
AML bone marrow biopsies before and after treatment and clinical data were retrospectively collected from patients treated with HMAs, to find features that would help to identify potential responders early during treatment. The bone marrow of AML patients is characterized by the presence of many malignant immature cells, that after a successful treatment are “washed away”. The treatment, however, also impacts the few remaining normal stem cells that are still present in the bone marrow and will have to repopulate the bone marrow after the treatment. Some of the patients treated with HMAs, showed an excessive growth response of red blood cell progenitors in the bone marrow after HMA treatment. This pattern was named Erythroid Dominant Response (EDR).
Approximately 90% of the patients developing EDR showed a response to HMAs, whereas only 14% of the other patients had a response. Upon confirmation of the clinical value of the EDR pattern in follow-up studies, EDR may offer the possibility to spare patients from inadequate treatment, and prioritize them for alternatives.
About the publication
Francesca Tiso, Konnie M. Hebeda, Saskia M.C. Langemeijer, Aniek O. de Graaf, Joost H.A. Martens, Thessa N. Koorenhof-Scheele, Ruth Knops, Leonie I. Kroeze, Bert A. van der Reijden, Joop H. Jansen; Erythroid Predominance in Bone Marrow Biopsies of Acute Myeloid Leukemia Patients after Decitabine Treatment Correlates with Mutation Profile and Complete Remission. Pathobiology 2 October 2024; 91 (5): 326–337.
