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Mutations of the isocitrate dehydrogenase-1 (IDH1) and IDH2 genes are among the most frequent alterations in acute myeloid leukemia (AML) and can be found in ∼20% of patients at diagnosis. Among 4930 patients (median age, 56 years; interquartile range, 45-66) with newly diagnosed, intensively treated AML, we identified IDH1 mutations in 423 (8.6%) and IDH2 mutations in 575 (11.7%). Overall, there were no differences in response rates or survival for patients with mutations in IDH1 or IDH2 compared with patients without mutated IDH1/2. However, distinct clinical and comutational phenotypes of the most common subtypes of IDH1/2 mutations could be associated with differences in outcome. IDH1-R132C was associated with increased age, lower white blood cell (WBC) count, less frequent comutation of NPM1 and FLT3 internal tandem mutation (ITD) as well as with lower rate of complete remission and a trend toward reduced overall survival (OS) compared with other IDH1 mutation variants and wild-type (WT) IDH1/2. In our analysis, IDH2-R172K was associated with significantly lower WBC count, more karyotype abnormalities, and less frequent comutations of NPM1 and/or FLT3-ITD. Among patients within the European LeukemiaNet 2017 intermediate- and adverse-risk groups, relapse-free survival and OS were significantly better for those with IDH2-R172K compared with WT IDH, providing evidence that AML with IDH2-R172K could be a distinct entity with a specific comutation pattern and favorable outcome. In summary, the presented data from a large cohort of patients with IDH1/2 mutated AML indicate novel and clinically relevant findings for the most common IDH mutation subtypes.
Simple Summary: Acute myeloid leukemia (AML) is a genetically heterogeneous disease. Clinical phenotypes of frequent mutations and their impact on patient outcome are well established. However, the role of rare mutations often remains elusive. We retrospectively analyzed 1529 newly diagnosed and intensively treated AML patients for mutations of BCOR and BCORL1. We report a distinct co-mutational pattern that suggests a role in disease progression rather than initiation, especially affecting mechanisms of DNA-methylation. Further, we found loss-of-function mutations of BCOR to be independent markers of poor outcomes in multivariable analysis. Therefore, loss-of-function mutations of BCOR need to be considered for AML management, as they may influence risk stratification and subsequent treatment allocation.
Abstract: Acute myeloid leukemia (AML) is characterized by recurrent genetic events. The BCL6 corepressor (BCOR) and its homolog, the BCL6 corepressor-like 1 (BCORL1), have been reported to be rare but recurrent mutations in AML. Previously, smaller studies have reported conflicting results regarding impacts on outcomes. Here, we retrospectively analyzed a large cohort of 1529 patients with newly diagnosed and intensively treated AML. BCOR and BCORL1 mutations were found in 71 (4.6%) and 53 patients (3.5%), respectively. Frequently co-mutated genes were DNTM3A, TET2 and RUNX1. Mutated BCORL1 and loss-of-function mutations of BCOR were significantly more common in the ELN2017 intermediate-risk group. Patients harboring loss-of-function mutations of BCOR had a significantly reduced median event-free survival (HR = 1.464 (95%-Confidence Interval (CI): 1.005–2.134), p = 0.047), relapse-free survival (HR = 1.904 (95%-CI: 1.163–3.117), p = 0.01), and trend for reduced overall survival (HR = 1.495 (95%-CI: 0.990–2.258), p = 0.056) in multivariable analysis. Our study establishes a novel role for loss-of-function mutations of BCOR regarding risk stratification in AML, which may influence treatment allocation.
Recent psychophysical research supports the notion that horizontal information of a face is primarily important for facial identity processes. Even though this has been demonstrated to be valid for young adults, the concept of horizontal information as primary informative source has not yet been applied to older adults’ ability to correctly identify faces. In the current paper, the role different filtering methods might play in an identity processing task is examined for young and old adults, both taken from student populations. Contrary to most findings in the field of developmental face perception, only a near-significant age effect is apparent in upright and un-manipulated presentation of stimuli, whereas a bigger difference between age groups can be observed for a condition which removes all but horizontal information of a face. It is concluded that a critical feature of human face perception, the preferential processing of horizontal information, is less efficient past the age of 60 and is involved in recognition processes that undergo age-related decline usually found in the literature.
Faces are thought to be processed primarily according to their configurations which is in-ferred from comparisons with non-facial stimuli. While the whole (face) seems to be more than the sum of its parts, the same does not apply to objects which are processed analytically according to their featural information. A recent recognition model stresses the importance of certain visual information within facial stimuli. By applying a specific filtering technique, stimuli can be generated that are restricted to contain information of only a certain orienta-tion. Dakin and Watt (2009) reported greatest recognition performance with faces that only contained horizontally aligned information with accuracy continuously declining at vertical. Furthermore, they showed that, compared with images of natural scenes, horizontal contours within faces have an unusual tendency to fall into vertically co-aligned clusters which were labelled biological ‘bar code’ referring to a highly constrained one-dimensional code. Con-secutive research tested for face-specific processing by comparing faces and objects that displayed information of different orientations. Results suggested configural processing only for faces that contained horizontal information (Goffaux & Dakin, 2010). The findings con-tribute important insight on a still unanswered question in face processing research: what information is extracted from faces for recognizing them. Despite the importance of remembering human faces on a daily basis, this ability seems to develop disadvantageously over lifetime. Decreased accuracy cannot be attributed to de-creased general cognitive ability (Hildebrandt, Wilhelm, Schmiedek, Herzmann, & Sommer, 2011) and slower reactions times are assumed to be a product of decision making rather than sensory speed (Habak, Wilkinson, & Wilson, 2008). Considering the amount of published work on face recognition, there is a lack of studies available assessing this important ability at a higher age. New theoretical concepts are rarely examined with older participants, appar-ently assuming their general validity. The current dissertation tries to help fill this gap by assessing the importance of horizontal information from a developmental perspective com-paring younger and older adults under different experimental variations. The first study showed, that presenting older participants with horizontally filtered faces has a dispropor-tional negative impact on recognizing younger unfamiliar faces suggesting differential pro-cessing mechanisms, since recognizing stimuli that only contained vertical information did not differ between age groups. On this basis, the following study manipulated the presented stimulus material, since some evidence suggests that own-age faces are more easily recog-nized compared to faces of other ages, which is referred to as “own-age bias”. Therefore, the second study systematically assessed the impact of stimulus age on recognition sensitivity. Moreover, encoding modalities were varied by providing increased exposure duration to the stimuli. The results of the first study were replicated, as older participants’ performance was still poor at recognizing younger faces, independent from encoding modalities. However, similar face recognition sensitivity compared to younger adults was observable when filtered faces of the older adults’ own age had to be recognized. Interestingly, correlations between recognizing filtered and unfiltered faces were obtained for younger adults but not for older adults suggesting age variant processing of horizontal information. The last study assessed the importance of horizontal information with stimulus material familiar to the observer. Although research highlights differences between recognizing unfamiliar and familiar stimu-lus material, this factor is often not considered by contemporary research. By presenting par-ticipants with their own faces, a stimulus of greatest individual familiarity was chosen. The superiority of own face recognition over other familiar material is referred to as “self-face advantage” and has been shown in comparison with personally familiar faces (Keyes & Brady, 2010) and famous faces (Caharel et al., 2002). While younger adults indeed recog-nized their self-faces better compared to famous faces independent from stimuli being fil-tered or unfiltered, older participants displayed a completely different pattern including the inability to recognize their filtered self-faces. Again, significant associations were obtained between filtered and unfiltered recognition conditions suggesting convergent processing mechanisms for younger adults but not for the older age group. This dissertation provides a first insight in the divergence of response behavior in older adults with a recent face processing model. While the obtained data undermine the im-portance of horizontal information in younger adults by replicating and extending previously published work, a profoundly different type of processing is suggested at a higher age which largely relies on low-level pictorial information due to the inability to process horizontally filtered faces configurally. Specifically, it is suggested that with age, focusing on aging-salient features with configural processing disrupted may function as a critical source of di-agnostic information which can ultimately result in performance similar to younger adults.
A complex aberrant karyotype consisting of multiple unrelated cytogenetic abnormalities is associated with poor prognosis in patients with acute myeloid leukemia (AML). The European Leukemia Net classification and the UK Medical Research Council recommendation provide prognostic categories that differ in the definition of unbalanced aberrations as well as the number of single aberrations. The aim of this study on 3526 AML patients was to redefine and validate a cutoff for karyotype complexity in AML with regard to adverse prognosis. Our study demonstrated that (1) patients with a pure hyperdiploid karyotype have an adverse risk irrespective of the number of chromosomal gains, (2) patients with translocation t(9;11)(p21~22;q23) have an intermediate risk independent of the number of additional aberrations, (3) patients with greater than or equal to4 abnormalities have an adverse risk per se and (4) patients with three aberrations in the absence of abnormalities of strong influence (hyperdiploid karyotype, t(9;11)(p21~22;q23), CBF-AML, unique adverse-risk aberrations) have borderline intermediate/adverse risk with a reduced overall survival compared with patients with a normal karyotype.