Recent literature demonstrates the importance of cytogenetic analysis in the correct diagnosis and treatment of neoplastic conditions. Often the most important therapeutic choices are based on the results of cytogenetic testing, underscoring the critical need for high-functioning cytogenetic laboratories. AML and chronic myelogenous leukemia (CML) represent key examples of diseases that illustrate this connection.
In 2009, La Agrupación Mexicana para el Estudio de la Hematología (AMEH) approached ASH to express their concern about the capacity of cytogenetic laboratories in Mexico to properly diagnose both AML and CML. Following these discussions, AMEH and ASH invited the U.S. National Cancer Institute (NCI) Office of Latin American Cancer Program Development to form a partnership dedicated to improving clinical management and research for the treatment of acute myeloid leukemia (AML) in Mexico. Four participating Mexican laboratories have been selected to participate in the two-year program alongside some of the foremost investigators in the fields of cytogenetics and AML.
The primary goal of this collaborative effort is to conduct a cytogenetics standardization protocol to improve the clinical cytogenetic analysis of hematological malignant diseases, including AML, in Mexico. The secondary goal is to create a sustainable program by developing cytogenetics training hubs to help standardize the analytical procedures in other laboratories in Mexico.
The initial stage of this pilot commences on April 8, 2011, in Mexico Citywitha workshop dedicated to developing the protocol for standardization. The workshop will include presentations and state-of-the-science talks supplemented by discussions on how best to implement the protocol and develop appropriate processes.
Following this workshop, the participating Mexican laboratories will begin to analyze samples and enter data into the Pediatric Oncology Network Database (POND), facilitated by St. Jude Children’s Research Hospital. The Scientific Subcommittee, composed of both cytogenetics and hematopathology experts from AMEH, ASH, and NCI, will analyze these data and provide feedback to the participating laboratories on a quarterly basis while the laboratories will meet periodically to discuss the results.
Cytogenetic analysis will be performed prospectively on all patients, both adults and children, at diagnosis of AML at the four participating institutions. Results of the analyses (representative karyotypes and data) will be centrally reviewed by two of the three Steering Committee cytogeneticists, Drs. Dianne Arthur, Michelle Le Beau, and Susan Raimondi. The reviewers will come to consensus about the quality, disposition, and final interpretation of the case.
Every three months the Steering Committee cytogeneticists will generate a Performance Summary based upon the Review Forms for each of the Cytogenetics Laboratories. Progress and trends will be monitored over time to assure laboratories are meeting the established short and long-term goals.
Over the course of the project, it is anticipated that clonal cytogenetic abnormalities will be found in more than 50 percent of the patients, and that at least half of these will be specific, recurring abnormalities useful in diagnosis and classification of the patients. Mexican clinicians may also use these results for patient management and future correlations with molecular genetic and epidemiologic studies.
The steering committee for this project includes the following representatives from AMEH, ASH, and NCI:
Agrupación Mexicana para el Estudio de la Hematología
David Gómez Almaguer, MD, PhD
Universidad de Nueva Leon, Monterrey, Mexico
Hector Mayani, PhD
National Medical Center, IMSS, Mexico DF, Mexico
American Society of Hematology
Michelle Le Beau, PhD
Cancer Research Center, University of Chicago, Chicago, IL, USA
LoAnn Peterson, MD
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Susana Raimondi, PhD
St. Jude Children’s Research Hospital, Memphis, TN, USA
National Cancer Institute
Diane Arthur, PhD
Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
Jorge Gomez, MD, PhD
Director, OLACPD, National Cancer Institute, Bethesda, MD, USA