Comprehensive Molecular and Clinical Evaluation of Pediatric and Adult MDS

Background:

• Myelodysplastic syndromes (MDS) are heterogenous stem cell disorders characterized by ineffective hematopoiesis resulting in cellular dysplasia, peripheral cytopenias, and increased risk for transformation to acute myeloid leukemia (AML).
• There are limited treatments options, all of which have unimpressive response rates and limited response durations, with the only potential cure being hematopoietic stem cell transplant (HSCT). Unfortunately, as a disease of the elderly (average age of diagnosis >65 years), most participants are not eligible for HSCT due to advanced age and other comorbidities.
• It is critical we further elucidate the processes that lead to disease manifestation in an effort to develop novel therapeutic strategies and to alter the natural history of the disease.
• Chronic inflammation is central to disease pathology, as evidenced by pro-inflammatory cytokines in the bone marrow milieu, transcriptional upregulation of inflammatory genes, and dysregulation of innate immune signaling pathways.
• We hypothesize the chronic inflammation drives MDS pathogenesis and may be exploited therapeutically. Further, we anticipate the correlatives proposed here to be used not only to uncover critical disease driving pathways, but also to potentially reveal disease and treatment response biomarkers, as well to better refine both diagnosis and prognosis.

Objectives:

• To characterize the natural history of myelodysplastic syndromes (MDS) and to assess overall and progression free survival

Eligibility:

Participants with MDS

• Either sex, any age
• Histologically or cytologically suspected or confirmed MDS, MDS/MPN, (MDS/MPN- RS-T, MDS/MPN-U, CMML, aCML) or sAML with antecedent MDS or MDS/MPN

OR

• diagnosis with a precursor condition that is associated with a risk of progression to MDS.
• Any amount of prior therapy and may be currently receiving MDS-directed therapy.
• Must have an identified primary oncologist, hematologist or generalist outside NIH who agrees to manage care and any diagnostic findings provided by this study.

Controls

• Either sex and must be eligible for marrow donation per clinical center requirements.
• No history of hematological malignancies listed as inclusion criteria for the group of participants with MDS or current autoimmune disease
• Control marrow volunteers must be scheduled for bone marrow harvest for clinical application, or if evaluated for malignancy, have a bone marrow aspirate scheduled to rule out bone marrow involvement at which time additional samples will be taken as controls for the research purposes of this study.

Design:

• This is a natural history and biospecimen acquisition protocol for participants with Myelodysplastic Syndromes (MDS).
• In addition, we will perform a comprehensive research analysis based on the hypothesis that chronic inflammation in MDS arising from a variety of contributors results in hematopoietic differentiation and maturation blocks leading to dysplasia, cytopenias, and disease progression, and that these may be exploited for novel therapeutic targeting strategies.
• This is a single site (Clinical Center) study that will accrue 1000 MDS participants and 100 marrow controls (transplant donor or non-involved malignancy) volunteers over a 20-year study accrual duration.
• Diagnostic testing will be performed as is routine for these participants in addition to planned research correlative analyses. Follow-up will occur approximately annually to assess status and survival.

• INCLUSION CRITERIA - MDS Participants
• Either sex, any age.
• Histologically or cytologically suspected or confirmed myelodysplastic syndromes (MDS), myelodysplastic syndromes/myeloproliferative neoplasms (MDS/MPN), MDS/myeloproliferative neoplasm with ringed sideroblasts and thrombocytosis (MDS/MPN-RS-T), myelodysplastic syndromes/myeloproliferative neoplasms unclassified (MDS/MPN-U), chronic myelomonocytic leukemia (CMML), atypical chronic myeloid leukemia (aCML), secondary acute myeloid leukemia (sAML) with antecedent MDS or MDS/MPN, or participants who have precursor conditions that are associated with a risk of progression to MDS, including but not limited to clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of unknown significance (CCUS).
• Participants may have had any amount of prior therapy and may be receiving MDS-directed therapy at time of enrollment.
• Participants must have an identified primary oncologist, hematologist or generalist outside of NIH who agrees to manage participant care and any diagnostic findings provided by this study.

Inclusion criteria

- Marrow Control Donor Participants

• Either sex, and must be eligible for marrow donation per NIH Clinical Center requirements.
• No history of hematological malignancies as listed as inclusion in 'Inclusion Criteria - MDS Participants' or current autoimmune disease.
• Must be scheduled for bone marrow harvest for clinical application (e.g., marrow donation); or, if being evaluated for malignancy, have a clinical bone marrow aspirate scheduled (e.g., to rule out bone marrow involvement).

Inclusion criteria

- All Participants

• Stated willingness to comply with all study procedures and availability for the duration of the study.
• Ability of participant or parent/guardian to understand and the willingness to sign a written consent document.

Exclusion criteria

- All Participants

-Uncontrolled intercurrent illness, psychiatric illness, or other that would limit compliance with study requirements, or at the investigator s discretion.