Ethical and Analytic Challenges With Genomic Sequencing of Relapsed Hematologic Malignancies Following Allogeneic Hematopoietic Stem-Cell Transplantation.
Bilal MarwaJoerg KruegerElizabeth A StephensonScott DavidsonDavid S AllanBartha Maria KnoppersMa'n ZawatiPatrick SullivanAdam ShlienDavid MalkinConrad V FernandezAnita VillaniPublished in: JCO precision oncology (2022)
The implementation of precision medicine and next-generation sequencing technologies in the field of oncology is a novel approach being more widely studied and used in cases of high-risk primary and recurrent malignancies. Leukemias are the second most common cause of cancer-related mortality in children and the sixth most in adults. Relapsed leukemia represents a major component of the population that may benefit from genomic sequencing. However, ethical and analytic challenges arise when considering sequencing of biologic samples obtained from patients with relapsed leukemia following allogeneic hematopoietic stem-cell transplantation. Blood from the recipient after transplantation would include donor-derived cells and thus, genomic sequencing of recipient blood will interrogate the donor germline in addition to the somatic genetic profile of the leukemia cells and the recipient germline. This is a situation for which the donor will not have typically provided consent and may be particularly problematic if actionable secondary or incidental findings related to the donor are uncovered. We present the challenges raised in this scenario and provide strategies to mitigate this risk.
Keyphrases
- acute myeloid leukemia
- allogeneic hematopoietic stem cell transplantation
- acute lymphoblastic leukemia
- copy number
- induced apoptosis
- single cell
- cell cycle arrest
- rheumatoid arthritis
- healthcare
- genome wide
- dna repair
- bone marrow
- hodgkin lymphoma
- young adults
- palliative care
- coronary artery disease
- cell death
- cardiovascular events
- stem cells
- mesenchymal stem cells
- cell proliferation
- dna damage
- pi k akt
- drug induced