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Persistent Malignant Stem Cells in del(5q) Myelodysplasia in Remission
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2010 (English)In: New England Journal of Medicine, ISSN 0028-4793, Vol. 363, no 11, 1025-1037 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND The in vivo clinical significance of malignant stem cells remains unclear. METHODS Patients who have the 5q deletion (del[5q]) myelodysplastic syndrome (interstitial deletions involving the long arm of chromosome 5) have complete clinical and cytogenetic remissions in response to lenalidomide treatment, but they often have relapse. To determine whether the persistence of rare but distinct malignant stem cells accounts for such relapses, we examined bone marrow specimens obtained from seven patients with the del(5q) myelodysplastic syndrome who became transfusion-independent while receiving lenalidomide treatment and entered cytogenetic remission. RESULTS Virtually all CD34+, CD38+ progenitor cells and stem cells that were positive for CD34 and CD90, with undetectable or low CD38 (CD38-/low), had the 5q deletion before treatment. Although lenalidomide efficiently reduced these progenitors in patients in complete remission, a larger fraction of the minor, quiescent, CD34+, CD38-/low, CD90+ del(5q) stem cells as well as functionally defined del(5q) stem cells remained distinctly resistant to lenalidomide. Over time, lenalidomide resistance developed in most of the patients in partial and complete remission, with recurrence or expansion of the del(5q) clone and clinical and cytogenetic progression. CONCLUSIONS In these patients with the del(5q) myelodysplastic syndrome, we identified rare and phenotypically distinct del(5q) myelodysplastic syndrome stem cells that were also selectively resistant to therapeutic targeting at the time of complete clinical and cytogenetic remission. (Funded by the EuroCancerStemCell Consortium and others.)

Place, publisher, year, edition, pages
2010. Vol. 363, no 11, 1025-1037 p.
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Medical and Health Sciences
URN: urn:nbn:se:kth:diva-61158DOI: 10.1056/NEJMoa0912228ISI: 000281609700006OAI: diva2:478651
QC 20120117Available from: 2012-01-16 Created: 2012-01-16 Last updated: 2012-01-17Bibliographically approved

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Rydén, Tobias
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