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  • 1
    Publication Date: 2014-12-06
    Description: Introduction Multiple Myeloma (MM) is a heterogeneous disease with diverse gene expression patterns (GEP) across patients. This has led to the development of various signatures allowing virtual karyotyping, defining different clusters of patients, and prognostication by high risk signatures (e.g. EMC92/SKY92). Several GEP datasets exist, but may have scaling/offset differences (batch effects) in the data, e.g. due to differences in reagents used, location, etc. Batch wise normalization approaches can reduce batch effects, and have allowed successful validation of those signatures across independent datasets. Batch wise normalization requires groups of patients that have a similar distribution of clinical characteristics, and hence cannot be applied on single patients. Here we demonstrate the validity of applying GEP algorithms on single patients using the MMprofiler, enabling the application of GEP in a routine clinical setting. Materials and Methods The MMprofiler GEP assay is a standardized assay from bone marrow to data analysis and result reporting. It was used for 77 MM patients that were enrolled in the HOVON87/NMSG18 trial (73 patients) or HOVON95/EMN02 trial (4 patients). A representative reference set of 30 HOVON patients was selected from which normalization parameters were derived, to be used for normalization of a single sample against this HOVON reference dataset. The remaining 47 samples served as an independent set of samples. In addition, we have also used the publicly available GEP data from 247 patients (MRC-IX trial) as independent samples. This MRC-IX dataset has been produced using different reagents and sample work-up procedures. Therefore, it is likely that a batch effect will exist relative to the HOVON reference dataset, which may influence correctness of single sample analyses. The GEP data from the 47 and 247 independent samples were normalized using two approaches. Firstly, by batch wise mean variance normalization (i.e. across the 47 and 247 patient batches separately). And secondly, by single sample normalization using the normalization parameters from the initial 30 HOVON samples. Subsequently, several classifiers (EMC92/SKY92 etc.) were applied to the data, and their results were compared between the two normalization approaches. Results Figure 1 shows the EMC92/SKY92 scores that were obtained after batch normalization (x-axis) and single sample normalization (y-axis). For the 47 HOVON samples there is a high degree of concordance with data points close to the identity line (y=x). Only 2 out of the 47 samples would switch assignment, which is not unexpected since those 2 samples are really close to the threshold (e.g. might also switch due to technical variation). For the MRC-IX dataset, based on single sample normalization more patients would be predicted as high risk (87 (35.2%) instead of 52 (21.0%), see Figure 1), which is caused by a positive offset (i.e. intersect with the y-axis) due to the batch effect. For the Virtual t(4;14) classifier, both datasets have a very high concordance with 0 out 47 HOVON samples, and 5 out of 247 MRC-IX samples (but really close to the threshold) switching assignment (see Figure 1). Hence, even in the presence of a potential batch effect in the MRC-IX dataset, the single sample predictions are accurate. These data suggest that single sample normalization of microarray GEP is possible but requires the strict standardization of the MMprofiler assay and algorithms. Conclusions Scores for the EMC92/SKY92 signature were nearly equivalent when derived from the data following single sample normalization and batch normalization in the Skyline generated data. In the external dataset, a much higher discrepancy was found, highlighting the need to use highly standardized methods to generate Affymetrix GeneChip results. Further validation of this method is planned, and will include replicate runs systematically controlled for various conditions. Acknowledgments This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine, project BioCHIP grant 03O-102. Figure 1. Scatterplots and confusion matrices of the batch (x-axis, columns) and single sample scores (y-axis, rows) of the EMC92/SKY92 signature (left), and Virtual t(4;14) classifier (right). Scores above/below the threshold correspond to high risk/standard risk (EMC92/SKY92) and positive/negative (Virtual t(4;14)). Figure 1. Scatterplots and confusion matrices of the batch (x-axis, columns) and single sample scores (y-axis, rows) of the EMC92/SKY92 signature (left), and Virtual t(4;14) classifier (right). Scores above/below the threshold correspond to high risk/standard risk (EMC92/SKY92) and positive/negative (Virtual t(4;14)). Disclosures Van Vliet: SkylineDX: Employment. Dumee:SkylineDx: Employment. de Best:SkylineDx: Employment. Sonneveld:SkylineDx: Membership on an entity's Board of Directors or advisory committees. van Beers:SkylineDX: Employment.
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 2
    Publication Date: 2014-12-06
    Description: Introduction High rates of complete response (CR) have previously been demonstrated in KRd-treated NDMM pts in a phase 1/2 trial (trial 1; NCT01029054) and a phase 2 trial that combined KRd with autologous stem cell transplant (ASCT) (trial 2; NCT01816971). Here, we report results of extended follow-up from the 2 trials and correlate response and PFS with GEP performed using the MMprofiler GEP assay, which provides results for the SKY92 signature, 7 virtual karyotyping markers (t[4;14], t[11;14], t[14;16]/t[14;20], gain[1q], del[13q], del[17p], H-MM [virtual gain(9q)]), and 3 clusters (MF, MS, CD2). Previously, a combination of 5 markers (SKY92, virtual gain[1q], virtual t[14;16]/t[14;20], MF and CD2 clusters) was identified that predicts improved outcomes when treated with the proteasome inhibitor (PI) bortezomib (van Vliet et al, EHA 2014). We evaluated the SKY92 prognostic signature, virtual karyotyping markers, and this 5-marker PI predictor signature in order to confirm these markers as predictive signatures in the KRd setting. Materials and Methods In the consecutive trials 1 and 2, pts received 4 cycles of KRd induction, followed by extended KRd treatment with deferred ASCT (trial 1; NCT01029054) or ASCT followed by extended KRd treatment (trial 2; NCT01816971). In both trials, pts received single-agent lenalidomide as maintenance after completion of KRd. The MMprofiler GEP assay was performed on RNA from CD138+ purified plasma cells. As depth of response with KRd is associated with improved time-to-event outcomes (Jasielec et al, ASH 2013), data were analyzed for associations between any of the MMprofiler markers and the groups that achieved ≥near CR (nCR) vs
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 3
    Publication Date: 2011-11-18
    Description: Abstract 4876 Background. In newly diagnosed acute myeloid leukemia (AML) gene expression (RNA) profiling (GEP) (1) on Affymetrix GeneChips identifies homogeneous clusters that correlate with all favorable cytogenetic subtypes t(15;17), t(8;21) and inv(16)/t(16;16) and favourable CEBPA gene double mutants (2). We validated the use of GEP to detect NPM1 type A/B/D with specifically designed probes and validated the prognostic value of qualitative (high vs low) assays for single genes (EVI1 and BAALC). Aims. To develop and validate an in vitro diagnostic (CE-IVD) microarray for use in newly diagnosed AML. Methods. A custom Affymetrix microarray, the AMLprofiler, was produced that contains a combination of generic and specially designed probes. The array was tested following hybridisation of 261 AML training cases. Next, the AMLprofiler was evaluated in an independent cohort of 267 unselected newly diagnosed cases of AML (Erasmus University Medical Center & University Ulm). Results. During validation in 267 independent cases the AMLprofiler identified 18/17 inv(16), 7/7 t(15;17) and 16/16 t(8;21) AML's and 70/71 NPM1A/B/D cases. There was one false-positive inv(16) namely a t(11;16) translocation concurrent with MYH11 overexpression, suggesting involvement of the 16p13.1 breakpoint as in bona fide inv(16). There was 1 false-negative case of NPM1 type-D, which motivated algorithm retraining and subsequent independent re-validation, resulting in detecting 68/66 NPM1AB/D mutants in 143 Normal Karyotype AML cases. One of the FP cases is a true and relevant but non-A/B/D type mutant. The EVI1 and BAALC cut points were validated in an independent clinical cohort resulting in p 〈 0.05 in the logrank test for OS between high versus low expressing intermediate cytogenetic risk cases. Finally, reproducibility of the AMLprofiler assay is demonstrated across 5 independent laboratories in four countries. Summary/conclusions. We report the development of an AML gene expression RNA microarray for diagnostic use that can be applied by physicians in their own laboratories, to detect core binding AML, PML, NPM1 A/B/D mutant, CEBPA double mutant, high EVI1 and low BAALC AML cases for diagnostic use Disclosures: van Beers: Skyline Diagnostics: Employment, Patents & Royalties. de Best:Skyline Diagnostics: Employment. van Vliet:Skyline Diagnostics: Employment. Brand:Skyline Diagnostics: Employment. Burgmer:Skyline Diagnostics: Employment. de Quartel:Skyline Diagnostics: Employment. Dumee:Skyline Diagnostics: Employment. Provoost:Skyline Diagnostics: Employment. Valk:Skyline Diagnostics: Equity Ownership. van der Spek:Skyline Diagnostics: Equity Ownership. Vietor:Skyline Diagnostics: Employment, Equity Ownership. Lowenberg:Skyline Diagnostics: Equity Ownership.
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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  • 4
    Publication Date: 2015-12-03
    Description: Improved prognostication is required for multiple myeloma (MM). So far, marker development has been based on clinical trials with a study population predominantly younger than 65 years. However, the median age of newly diagnosed MM patients is 66 years old. Based on gene expression profiles of the HOVON-65/GMMG-HD4 dataset, we previously developed the EMC92 prognostic signature, consisting of 92 probe sets for improved prognostication in MM. The EMC92 was validated in the MRC-IX, TT2, TT3 and APEX datasets. These studies were mostly aimed at younger patients with a median age of 57 years. The EMC92 signature was subsequently developed for clinical use as part of the MMprofiler, and termed the SKY92 signature. To assess the validity of the SKY92 signature in older MM patients, we used the HOVON-87/NMSG-18 study, in which induction therapy with melphalan, prednisone and thalidomide, followed by thalidomide maintenance, was compared with melphalan, prednisone and lenalidomide, followed by lenalidomide maintenance (MPT-T vs. MPR-R). The median age of all patients included in this trial was 73 years, with 34% of patients 76 years or older. The median follow up of the patients still alive was 39 months. Of 143 patients both gene expression profiling and clinical data were available (median age 73; 30% ≥76; n=83 MPT-T; n=60 MPR-R). The MMprofiler was used to obtain SKY92 scores, classifying a patient as high risk or standard risk (MMprofiler- CE IVD assay, performed according to the manufacturers' instructions for use at the SkylineDx reference lab, Rotterdam, The Netherlands). The association between survival and the SKY92 signature was evaluated using Cox regression analysis. Kaplan-Meier curves were constructed for visualization. Using the SKY92 signature 22/143 patients were identified as high risk (15.4%). The median overall survival (OS) for high risk patients was 21 months, compared to 53 months for standard risk patients (hazard ratio (HR): 2.9 (95% confidence interval (CI): 1.6-5.4; p=5.6 x 10-4)). The median progression free survival (PFS) in the high risk and standard risk groups were 12 months and 23 months, respectively (HR: 2.2 (95% CI: 1.4-3.7; p=1.2 x 10-3)). In this subset of 143 patients, deletion of 17p (del17p) and gain of 1q (gain1q) were also adversely associated with OS in a univariate analysis. Including SKY92, del(17p) and gain(1q) in a multivariate model demonstrated that SKY92 and del(17p) remained significantly associated with OS (subset of 143 (n=101) with all data known; Table 1). We previously developed the combination of ISS with SKY92: low risk (ISS I-SKY92 standard risk (SR)), intermediate-low (ISS II-SKY92 SR), intermediate-high (ISS III-SKY92 SR) and high risk (ISS I-III, SKY92 high risk; Kuiper et al., ASH 2014, #3358). The Cox model for this combined marker has a p-value for the likelihood ratio test of p=3 x 10-3 for OS (Figure 2) and p=0.016 for PFS. In conclusion, the SKY92 signature (MMprofiler) is a useful prognostic marker to identify a high-risk subgroup in the elderly population. Figure 1. Performance of the SKY92 signature in the HOVON-87/NMSG-18 study. Red line indicates high risk patients (n=22), blue line indicates standard risk patients (n=121). PFS (A); OS (B). Figure 1. Performance of the SKY92 signature in the HOVON-87/NMSG-18 study. Red line indicates high risk patients (n=22), blue line indicates standard risk patients (n=121). PFS (A); OS (B). Table 1. SKY92 in relation to FISH markers in the HOVON-87/NMSG-18 (Hazard ratios (HR), 95% confidence intervals (CI) and p-values (2-sided; p) for Cox proportional hazards analysis). The multivariate analysis (bottom) was performed using the markers significant in the univariate analysis (top). Bold: p
    Print ISSN: 0006-4971
    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
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