Microarray-based classifiers and prognosis models identify subgroups with distinct clinical outcomes and high risk of AML transformation of myelodysplastic syndrome

The diagnosis of myelodysplastic syndrome (MDS) currently relies primarily on the morphologic assessment of the patient's bone marrow and peripheral blood cells. Moreover, prognostic scoring systems rely on observer-dependent assessments of blast percentage and dysplasia. Gene expression profiling could enhance current diagnostic and prognostic systems by providing a set of standardized, objective gene signatures. Within the Microarray Innovations in LEukemia study, a diagnostic classification model was investigated to distinguish the distinct subclasses of pediatric and adult leukemia, as well as MDS. Overall, the accuracy of the diagnostic classification model for subtyping leukemia was approximately 93%, but this was not reflected for the MDS samples giving only approximately 50% accuracy. Discordant samples of MDS were classified either into acute myeloid leukemia (AML) or

Two routes to leukemic transformation after a JAK2 mutation-positive myeloproliferative neoplasm

Acute myeloid leukemia (AML) may follow a JAK2-positive myeloproliferative neoplasm (MPN), although the mechanisms of disease evolution, often involving loss of mutant JAK2, remain obscure. We studied 16 patients with JAK2-mutant (7 of 16) or JAK2 wild-type (9 of 16) AML after a JAK2-mutant MPN. Primary myelofibrosis or myelofibrotic transformation preceded all 7 JAK2-mutant but only 1 of 9 JAK2 wild-type AMLs (P = .001), implying that JAK2-mutant AML is preceded by mutation(s) that give rise to a "myelofibrosis" phenotype. Loss of the JAK2 mutation by mitotic recombination, gene conversion, or deletion was excluded in all wild-type AMLs. A search for additional mutations identified alterations of RUNX1, WT1, TP53, CBL, NRAS, and TET2, without significant differences between JAK2-mutant and wild-type leukemias. In 4 patients, mutations in TP53, CBL, or TET2 were present in JAK2 wild-type leukemic blasts but absent from the JAK2-mutant MPN. By contrast in a chronic-phase patient, clones harboring mutations in JAK2 or MPL represented the progeny of a shared TET2-mutant ancestral clone. These results indicate that different pathogenetic mechanisms underlie transformation to JAK2 wild-type and JAK2-mutant AML, show that TET2 mutations may be present in a clone distinct from that harboring a JAK2 mutation, and emphasize the clonal heterogeneity of the MPNs.

Conflict, Transformation, and Former Loyalist Paramilitary Prisoners in Northern Ireland

Following the 1998 Belfast Agreement in Northern Ireland, levels of paramilitary violence have declined substantially. Among loyalists, the Ulster Volunteer Force (UVF) and associated Red Hand Commando (RHC) have formally renounced violence, and dissolved their 'military structures', and perhaps the most reticent of all of the major paramilitary groupings, the Ulster Defence Association (UDA), has taken on board the central tenets of conflict transformation, and 'stood down' all of its 'active service units' in the Ulster Freedom Fighters (UFF). Thus, paramilitary violence now is mainly confined to the activities of 'dissident' republican groups, notably the Real and Continuity IRAs, although low-level sectarian violence remains a problem. Such dramatic societal and political change has resulted in a focus on the roles of formal party political leadership as agents of social change. This gaze, however, tends to obscure other important events such as the efforts, structures and approaches taken at the grassroots level to uphold and sustain conflict transformation and to maintain a reduction in violence. This article provides analysis of the role played by former loyalist paramilitary combatants in conflict transformation, and draws on material obtained through significant access to those former paramilitaries engaged in processes of societal shifts. In both personal and structural terms there is evidence of former combatants working to diminish the political tensions that remain as a result of the long-term inter-communal hostility developed across decades of violence and conflict.

Re-imagining DDR Ex-combatants, leadership and moral agency in conflict transformation

Drawing upon criminological studies in the field of prisoner rehabilitation, this essay explores the relevance of the Demobilisation, Disarmament and Reintegration (DDR) framework to the process of conflict transformation in Northern Ireland. In a similar fashion to the critique of 'passivity' offered by, for example, the 'strengths based' or 'good lives' approach to prisoner resettlement and reintegration more generally, the authors contend that the Northern Ireland peace process offers conspicuous examples of former prisoners and combatants as agents and indeed leaders in the process of conflict transformation. They draw out three broad styles of leadership which have emerged amongst ex-combatants over the course of the Northern Ireland transition from conflict-political, military and communal. They suggest that cumulatively such leadership speaks to the potential of ex-prisoners and ex-combatants as moral agents in conflict transformation around which peacemaking can be constructed rather than as obstacles which must be 'managed' out of existence.

Resistance, transition and exclusion: Politically motivated ex-prisoners and conflict transformation in Northern Ireland

The landscape of political imprisonment in Northern Ireland was changed due to the general release and reintegration of politically motivated prisoners as part of the Belfast Agreement. This article reflects upon the post-prison experiences of former prisoners and their families, and in particular how the move from a resistant to a transitional framework has facilitated a greater openness and willingness amongs ex-prisoners to acknowledge the personal and familial problems related to incarceration. We also explore the ways in which ex-prisoners have attempted to deal with the continued social, political and civic exclusion which arises as a result of their conflict-related 'criminal' convictions. In the final section of the article, the authors further develop the move from a resistant to a transitional characterization of incarceration and its consequences.