Skip to main content
Erschienen in: Current Hematologic Malignancy Reports 6/2022

19.09.2022 | Germline Predisposition to Myeloid Neoplasms (M Patnaik, Section Editor)

Pediatric Germline Predisposition to Myeloid Neoplasms

verfasst von: Christineil Thompson, Sydney Ariagno, Mira A. Kohorst

Erschienen in: Current Hematologic Malignancy Reports | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Advances in the understanding of germline predisposition to pediatric cancers, particularly myeloid neoplasms, have increased rapidly over the last 20 years. Here, we highlight the most up-to-date knowledge regarding known pathogenic germline variants that contribute to the development of myeloid neoplasms in children.

Recent Findings

This discussion enumerates the most notable myeloid neoplasm-causing germline mutations. These mutations may be organized based on their molecular underpinnings—transcriptional control, splicing and signal transduction control, and a group of heterogeneous bone marrow failure syndromes. We review recent findings related to the biochemical mechanisms that predispose to malignant transformation in each condition. Key genetic discoveries such as novel mutations, degrees of penetrance, principles of the two-hit hypothesis, and co-occurrence of multiple mutations are shared. Clinical pearls, such as information regarding epidemiology, natural history, or prognosis, are also discussed.

Summary

Germline mutations predisposing to pediatric myeloid neoplasms are frequent, but underrecognized. They hold major clinical implications regarding prognosis, treatment strategies, and screening for other malignancies. Further research is warranted to better characterize each of these conditions, as well as identify additional novel germline pathogenic variants of interest.
Literatur
3.
Zurück zum Zitat Smith MA, Ries LA, Gurney JG, et al. Leukemia. In: Ries LA, Smith MA, Gurney JG, et al., eds.: Cancer incidence and survival among children and adolescents: United States SEER Program 1975–1995. National Cancer Institute, SEER Program, 1999;NIH 17–34. Smith MA, Ries LA, Gurney JG, et al. Leukemia. In: Ries LA, Smith MA, Gurney JG, et al., eds.: Cancer incidence and survival among children and adolescents: United States SEER Program 1975–1995. National Cancer Institute, SEER Program, 1999;NIH 17–34.
4.
Zurück zum Zitat Samaraweera SE, Wang PPS, Li KL, Casolari DA, Feng J, Pinese M, Maung KZY, Leo P, Cowley M, Perkins K, Smith AM, Ellis J, Wee A, Hiwase DK, Scott HS, Schreiber AW, Brown AL, Deans AJ, Ross DM, Moore AS, Gonda TJ, Hahn CN, D’Andrea RJ. Childhood acute myeloid leukemia shows a high level of germline predisposition. Blood. 2021;138(22):2293–8. https://doi.org/10.1182/blood.2021012666.CrossRefPubMed Samaraweera SE, Wang PPS, Li KL, Casolari DA, Feng J, Pinese M, Maung KZY, Leo P, Cowley M, Perkins K, Smith AM, Ellis J, Wee A, Hiwase DK, Scott HS, Schreiber AW, Brown AL, Deans AJ, Ross DM, Moore AS, Gonda TJ, Hahn CN, D’Andrea RJ. Childhood acute myeloid leukemia shows a high level of germline predisposition. Blood. 2021;138(22):2293–8. https://​doi.​org/​10.​1182/​blood.​2021012666.CrossRefPubMed
8.
Zurück zum Zitat Mannelli F, Ponziani V, Bencini S, Bonetti MI, Benelli M, Cutini I, Gianfaldoni G, Scappini B, Pancani F, Piccini M, Rondelli T, Caporale R, Gelli AM, Peruzzi B, Chiarini M, Borlenghi E, Spinelli O, Giupponi D, Zanghì P, Bassan R, Bosi A. CEBPA-double-mutated acute myeloid leukemia displays a unique phenotypic profile: a reliable screening method and insight into biological features. Haematologica. 2017;102(3):529–40. https://doi.org/10.3324/haematol.2016.151910.CrossRefPubMedPubMedCentral Mannelli F, Ponziani V, Bencini S, Bonetti MI, Benelli M, Cutini I, Gianfaldoni G, Scappini B, Pancani F, Piccini M, Rondelli T, Caporale R, Gelli AM, Peruzzi B, Chiarini M, Borlenghi E, Spinelli O, Giupponi D, Zanghì P, Bassan R, Bosi A. CEBPA-double-mutated acute myeloid leukemia displays a unique phenotypic profile: a reliable screening method and insight into biological features. Haematologica. 2017;102(3):529–40. https://​doi.​org/​10.​3324/​haematol.​2016.​151910.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Cheson BD, Bennett JM, Kopecky KJ, Büchner T, Willman CL, Estey EH, Schiffer CA, Doehner H, Tallman MS, Lister TA, Lo-Coco F, Willemze R, Biondi A, Hiddemann W, Larson RA, Löwenberg B, Sanz MA, Head DR, Ohno R, Bloomfield CD; International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. J Clin Oncol. 2003 Dec 15;21(24):4642–9. https://doi.org/10.1200/JCO.2003.04.036. Erratum in: J Clin Oncol. 2004;Feb 1;22(3):576. LoCocco, Francesco [corrected to Lo-Coco, Francesco]. Cheson BD, Bennett JM, Kopecky KJ, Büchner T, Willman CL, Estey EH, Schiffer CA, Doehner H, Tallman MS, Lister TA, Lo-Coco F, Willemze R, Biondi A, Hiddemann W, Larson RA, Löwenberg B, Sanz MA, Head DR, Ohno R, Bloomfield CD; International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. J Clin Oncol. 2003 Dec 15;21(24):4642–9. https://​doi.​org/​10.​1200/​JCO.​2003.​04.​036. Erratum in: J Clin Oncol. 2004;Feb 1;22(3):576. LoCocco, Francesco [corrected to Lo-Coco, Francesco].
12.
Zurück zum Zitat •• Kimura Y, Iwanaga E, Iwanaga K, et al. A regulatory element in the 3′-untranslated region of CEBPA is associated with myeloid/NK/T-cell leukemia. Eur J Haematol. 2021;106:327–39. https://doi.org/10.1111/ejh.13551. DNA methylation in the CEBPA 3′-untranslated region (UTR) is associated with myeloid/NK/T-cell leukemia and CEBPA downregulation. The CEBPA 3′-UTR has the enhancer-like activity that is positively controlled by IKZF1. The methylation testing of CEBPA 3′-UTR helps to classify myeloid/NK/T-cell leukemia.CrossRefPubMed •• Kimura Y, Iwanaga E, Iwanaga K, et al. A regulatory element in the 3′-untranslated region of CEBPA is associated with myeloid/NK/T-cell leukemia. Eur J Haematol. 2021;106:327–39. https://​doi.​org/​10.​1111/​ejh.​13551. DNA methylation in the CEBPA 3′-untranslated region (UTR) is associated with myeloid/NK/T-cell leukemia and CEBPA downregulation. The CEBPA 3′-UTR has the enhancer-like activity that is positively controlled by IKZF1. The methylation testing of CEBPA 3′-UTR helps to classify myeloid/NK/T-cell leukemia.CrossRefPubMed
16.
Zurück zum Zitat Swerdlow SH. Who classification of tumours of haematopoietic and lymphoid tissues. International Agency for Research on Cancer; 2017. Swerdlow SH. Who classification of tumours of haematopoietic and lymphoid tissues. International Agency for Research on Cancer; 2017.
18.
24.
Zurück zum Zitat •• Sahoo SS, Kozyra EJ, Wlodarski MW. Germline predisposition in myeloid neoplasms: unique genetic and clinical features of GATA2 deficiency and SAMD9/SAMD9L syndromes. Best Pract Res Clin Haematol. 2020;33(3):101197. https://doi.org/10.1016/j.beha.2020.101197. A great summary highlighting the current knowledge regarding the GATA2 and SAMD9/9L syndromes with all the key references and stakeholders.CrossRefPubMedPubMedCentral •• Sahoo SS, Kozyra EJ, Wlodarski MW. Germline predisposition in myeloid neoplasms: unique genetic and clinical features of GATA2 deficiency and SAMD9/SAMD9L syndromes. Best Pract Res Clin Haematol. 2020;33(3):101197. https://​doi.​org/​10.​1016/​j.​beha.​2020.​101197. A great summary highlighting the current knowledge regarding the GATA2 and SAMD9/9L syndromes with all the key references and stakeholders.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Asou H, Matsui H, Ozaki Y, Nagamachi A, Nakamura M, Aki D, et al. Identification of a common microdeletion cluster in 7q21.3 subband among patients with myeloid leukemia and myelodysplastic syndrome. Biochem Biophys Res Commun. 2009;383:245–51.CrossRefPubMed Asou H, Matsui H, Ozaki Y, Nagamachi A, Nakamura M, Aki D, et al. Identification of a common microdeletion cluster in 7q21.3 subband among patients with myeloid leukemia and myelodysplastic syndrome. Biochem Biophys Res Commun. 2009;383:245–51.CrossRefPubMed
28.
Zurück zum Zitat Narumi S, Amano N, Ishii T, Katsumata N, Muroya K, Adachi M, Toyoshima K, Tanaka Y, Fukuzawa R, Miyako K, et al. SAMD9 mutations cause a novel multisystem disorder, MIRAGE syndrome, and are associated with loss of chromosome 7. Nat Genet. 2016;48:792–7. https://doi.org/10.1038/ng.3569.CrossRefPubMed Narumi S, Amano N, Ishii T, Katsumata N, Muroya K, Adachi M, Toyoshima K, Tanaka Y, Fukuzawa R, Miyako K, et al. SAMD9 mutations cause a novel multisystem disorder, MIRAGE syndrome, and are associated with loss of chromosome 7. Nat Genet. 2016;48:792–7. https://​doi.​org/​10.​1038/​ng.​3569.CrossRefPubMed
29.
Zurück zum Zitat •• de Jesus AA, Hou Y, Brooks S, Malle L, Biancotto A, Huang Y, et al. Distinct interferon signatures and cytokine patterns define additional systemic autoinflammatory diseases. J Clin Invest. 2020;130(4):1669–82. A very interesting paper showing the correlation between immune-dysregulatory/autoinflammatory diseases and myeloid predisposition syndromes.CrossRefPubMedPubMedCentral •• de Jesus AA, Hou Y, Brooks S, Malle L, Biancotto A, Huang Y, et al. Distinct interferon signatures and cytokine patterns define additional systemic autoinflammatory diseases. J Clin Invest. 2020;130(4):1669–82. A very interesting paper showing the correlation between immune-dysregulatory/autoinflammatory diseases and myeloid predisposition syndromes.CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Sahoo SS, Pastor VP, Panda PK, Szvetnik EK, Kozyra EJ, Voss R, et al. SAMD9 and SAMD9L germline disorders in patients Enrolled in studies of the European working group of MDS in childhood (EWOG-MDS): prevalence, outcome, phenotype and functional characterisation. Blood. 2018;132(1):613. https://doi.org/10.1182/blood-2018-99-118389.CrossRef Sahoo SS, Pastor VP, Panda PK, Szvetnik EK, Kozyra EJ, Voss R, et al. SAMD9 and SAMD9L germline disorders in patients Enrolled in studies of the European working group of MDS in childhood (EWOG-MDS): prevalence, outcome, phenotype and functional characterisation. Blood. 2018;132(1):613. https://​doi.​org/​10.​1182/​blood-2018-99-118389.CrossRef
34.
Zurück zum Zitat Chen DH, Below JE, Shimamura A, Keel SB, Matsushita M, Wolff J, et al. Ataxia-pancytopenia syndrome is caused by missense mutations in SAMD9L. Am J Hum Genet. 2016;98:1146–58.CrossRefPubMedPubMedCentral Chen DH, Below JE, Shimamura A, Keel SB, Matsushita M, Wolff J, et al. Ataxia-pancytopenia syndrome is caused by missense mutations in SAMD9L. Am J Hum Genet. 2016;98:1146–58.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Thunstrom S, Axelsson M. Leukoencephalopathia, demyelinating peripheral neuropathy and dural ectasia explained by a not formerly described de novo mutation in the SAMD9L gene, ends 27 years of investigations - a case report. BMC Neurol. 2019;19:89.CrossRefPubMedPubMedCentral Thunstrom S, Axelsson M. Leukoencephalopathia, demyelinating peripheral neuropathy and dural ectasia explained by a not formerly described de novo mutation in the SAMD9L gene, ends 27 years of investigations - a case report. BMC Neurol. 2019;19:89.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Tesi B, Davidsson J, Voss M, Rahikkala E, Holmes TD, Chiang SC, et al. Gain-of-function SAMD9L mutations cause a syndrome of cytopenia, immunodeficiency. MDS and neurological symptoms Blood. 2017;129(16):2266–79.PubMed Tesi B, Davidsson J, Voss M, Rahikkala E, Holmes TD, Chiang SC, et al. Gain-of-function SAMD9L mutations cause a syndrome of cytopenia, immunodeficiency. MDS and neurological symptoms Blood. 2017;129(16):2266–79.PubMed
37.
Zurück zum Zitat Bluteau O, Sebert M, Leblanc T, Peffault de Latour R, Quentin S, Lainey E, et al. A landscape of germ line mutations in a cohort of inherited bone marrow failure patients. Blood. 2018;131:717–32.CrossRefPubMed Bluteau O, Sebert M, Leblanc T, Peffault de Latour R, Quentin S, Lainey E, et al. A landscape of germ line mutations in a cohort of inherited bone marrow failure patients. Blood. 2018;131:717–32.CrossRefPubMed
38.
Zurück zum Zitat Perisa MP, Rose MJ, Varga E, Kamboj MK, Spencer JD, Bajwa RPS. A novel SAMD9 variant identified in patient with MIRAGE syndrome: further defining syndromic phenotype and review of previous cases. Pediatr Blood Canc. 2019;66:e27726.CrossRef Perisa MP, Rose MJ, Varga E, Kamboj MK, Spencer JD, Bajwa RPS. A novel SAMD9 variant identified in patient with MIRAGE syndrome: further defining syndromic phenotype and review of previous cases. Pediatr Blood Canc. 2019;66:e27726.CrossRef
39.
Zurück zum Zitat Schwartz JR, Wang S, Ma J, Lamprecht T, Walsh M, Song G, et al. Germline SAMD9 mutation in siblings with monosomy 7 and myelodysplastic syndrome. Leukemia. 2017;31:1827–30.CrossRefPubMedPubMedCentral Schwartz JR, Wang S, Ma J, Lamprecht T, Walsh M, Song G, et al. Germline SAMD9 mutation in siblings with monosomy 7 and myelodysplastic syndrome. Leukemia. 2017;31:1827–30.CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat Wong JC, Bryant V, Lamprecht T, Ma J, Walsh M, Schwartz J, et al. Germline SAMD9 and SAMD9L mutations are associated with extensive genetic evolution and diverse hematologic outcomes. JCI Insight 2018:3 Wong JC, Bryant V, Lamprecht T, Ma J, Walsh M, Schwartz J, et al. Germline SAMD9 and SAMD9L mutations are associated with extensive genetic evolution and diverse hematologic outcomes. JCI Insight 2018:3
41.
Zurück zum Zitat Buonocore F, Kuhnen P, Suntharalingham JP, Del Valle I, Digweed M, Stachelscheid H, et al. Somatic mutations and progressive monosomy modify SAMD9- related phenotypes in humans. J Clin Invest. 2017;127(5):1700–13.CrossRefPubMedPubMedCentral Buonocore F, Kuhnen P, Suntharalingham JP, Del Valle I, Digweed M, Stachelscheid H, et al. Somatic mutations and progressive monosomy modify SAMD9- related phenotypes in humans. J Clin Invest. 2017;127(5):1700–13.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Niemeyer CM. Pediatric MDS including refractory cytopenia and juvenile myelomonocytic leukemia. In: th Carreras E, Dufour C, Mohty M, Kroger N, editors. The EBMT handbook: hematopoietic stem cell transplantation and cellular therapies; 2019 557–60. Cham (CH). Niemeyer CM. Pediatric MDS including refractory cytopenia and juvenile myelomonocytic leukemia. In: th Carreras E, Dufour C, Mohty M, Kroger N, editors. The EBMT handbook: hematopoietic stem cell transplantation and cellular therapies; 2019 557–60. Cham (CH).
43.
Zurück zum Zitat Molina JR, Adjei AA. The Ras/Raf/MAPK pathway. J Thorac Oncol. 2006;1(1):7–9 (PMID: 17409820).CrossRefPubMed Molina JR, Adjei AA. The Ras/Raf/MAPK pathway. J Thorac Oncol. 2006;1(1):7–9 (PMID: 17409820).CrossRefPubMed
47.
49.
Zurück zum Zitat Caye A, Strullu M, Guidez F, Cassinat B, Gazal S, Fenneteau O, Lainey E, Nouri K, Nakhaei-Rad S, Dvorsky R, et al. Juvenile myelomonocytic leukemia displays mutations in components of the RAS pathway and the PRC2 network. Nat Genet. 2015;47:1334–40. https://doi.org/10.1038/ng.3420.CrossRefPubMed Caye A, Strullu M, Guidez F, Cassinat B, Gazal S, Fenneteau O, Lainey E, Nouri K, Nakhaei-Rad S, Dvorsky R, et al. Juvenile myelomonocytic leukemia displays mutations in components of the RAS pathway and the PRC2 network. Nat Genet. 2015;47:1334–40. https://​doi.​org/​10.​1038/​ng.​3420.CrossRefPubMed
55.
Zurück zum Zitat Quesada AE, Routbort MJ, DiNardo CD, Bueso-Ramos CE, Kanagal-Shamanna R, Khoury JD, Thakral B, Zuo Z, Yin CC, Loghavi S, et al. DDX41 mutations in myeloid neoplasms are associated with male gender, TP53 mutations and high-risk disease. Am J Hematol. 2019;94:757–66.PubMed Quesada AE, Routbort MJ, DiNardo CD, Bueso-Ramos CE, Kanagal-Shamanna R, Khoury JD, Thakral B, Zuo Z, Yin CC, Loghavi S, et al. DDX41 mutations in myeloid neoplasms are associated with male gender, TP53 mutations and high-risk disease. Am J Hematol. 2019;94:757–66.PubMed
66.
Zurück zum Zitat Mundschau G, Gurbuxani S, Gamis AS, Greene ME, Arceci RJ, Crispino JD. Mutagenesis of GATA1 is an initiating event in Down syndrome leukemogenesis. Blood. 2003;101:4298–300.CrossRefPubMed Mundschau G, Gurbuxani S, Gamis AS, Greene ME, Arceci RJ, Crispino JD. Mutagenesis of GATA1 is an initiating event in Down syndrome leukemogenesis. Blood. 2003;101:4298–300.CrossRefPubMed
67.
Zurück zum Zitat Banno K, Omori S, Hirata K, Nawa N, Nakagawa N, Nishimura K, et al. Systematic cellular disease models reveal synergistic interaction of trisomy 21 and GATA1 mutations in hematopoietic abnormalities. Cell Rep. 2016;15:1228–41.CrossRefPubMed Banno K, Omori S, Hirata K, Nawa N, Nakagawa N, Nishimura K, et al. Systematic cellular disease models reveal synergistic interaction of trisomy 21 and GATA1 mutations in hematopoietic abnormalities. Cell Rep. 2016;15:1228–41.CrossRefPubMed
69.
Zurück zum Zitat Hollanda LM, Lima CS, Cunha AF, Albuquerque DM, Vassallo J, Ozelo MC, et al. An inherited mutation leading to production of only the short isoform of GATA-1 is associated with impaired erythropoiesis. Nat Genet. 2006;38:807–12.CrossRefPubMed Hollanda LM, Lima CS, Cunha AF, Albuquerque DM, Vassallo J, Ozelo MC, et al. An inherited mutation leading to production of only the short isoform of GATA-1 is associated with impaired erythropoiesis. Nat Genet. 2006;38:807–12.CrossRefPubMed
70.
Zurück zum Zitat Gamis AS, Alonzo TA, Gerbing RB, Hilden JM, Sorrell AD, Sharma M, Loew TW, Arceci RJ, Barnard D, Doyle J, Massey G, Perentesis J, Ravindranath Y, Taub J, Smith FO. Natural history of transient myeloproliferative disorder clinically diagnosed in Down syndrome neonates: a report from the Children’s Oncology Group Study A2971. Blood. 2011;118(26):6752–9. https://doi.org/10.1182/blood-2011-04-350017.CrossRefPubMedPubMedCentral Gamis AS, Alonzo TA, Gerbing RB, Hilden JM, Sorrell AD, Sharma M, Loew TW, Arceci RJ, Barnard D, Doyle J, Massey G, Perentesis J, Ravindranath Y, Taub J, Smith FO. Natural history of transient myeloproliferative disorder clinically diagnosed in Down syndrome neonates: a report from the Children’s Oncology Group Study A2971. Blood. 2011;118(26):6752–9. https://​doi.​org/​10.​1182/​blood-2011-04-350017.CrossRefPubMedPubMedCentral
Metadaten
Titel
Pediatric Germline Predisposition to Myeloid Neoplasms
verfasst von
Christineil Thompson
Sydney Ariagno
Mira A. Kohorst
Publikationsdatum
19.09.2022
Verlag
Springer US
Erschienen in
Current Hematologic Malignancy Reports / Ausgabe 6/2022
Print ISSN: 1558-8211
Elektronische ISSN: 1558-822X
DOI
https://doi.org/10.1007/s11899-022-00681-5

Weitere Artikel der Ausgabe 6/2022

Current Hematologic Malignancy Reports 6/2022 Zur Ausgabe

T-Cell and Other Lymphoproliferative Malignancies (R Mesa, Section Editor)

Circulating Tumor DNA in Lymphoma

T-Cell and Other Lymphoproliferative Malignancies (J Zain, Section Editor)

Bispecific Antibodies for the Treatment of Multiple Myeloma

Myeloproliferative Neoplasms (P Bose, Section Editor)

Molecular Pathogenesis of Myeloproliferative Neoplasms

Health Economics (N Khera, Section Editor)

Value in Myeloma Care: Myth or Reality

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

16.05.2024 alpha-1-Rezeptorantagonisten Nachrichten

Nach einer Prostatabiopsie treten häufig Probleme beim Wasserlassen auf. Ob sich das durch den periinterventionellen Einsatz von Alphablockern verhindern lässt, haben australische Mediziner im Zuge einer Metaanalyse untersucht.

Antikörper-Wirkstoff-Konjugat hält solide Tumoren in Schach

16.05.2024 Zielgerichtete Therapie Nachrichten

Trastuzumab deruxtecan scheint auch jenseits von Lungenkrebs gut gegen solide Tumoren mit HER2-Mutationen zu wirken. Dafür sprechen die Daten einer offenen Pan-Tumor-Studie.

Mammakarzinom: Senken Statine das krebsbedingte Sterberisiko?

15.05.2024 Mammakarzinom Nachrichten

Frauen mit lokalem oder metastasiertem Brustkrebs, die Statine einnehmen, haben eine niedrigere krebsspezifische Mortalität als Patientinnen, die dies nicht tun, legen neue Daten aus den USA nahe.

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

13.05.2024 Pankreaskarzinom Nachrichten

Gerade bei aggressiven Malignomen wie dem duktalen Adenokarzinom des Pankreas könnte Früherkennung die Therapiechancen verbessern. Noch jedoch klafft hier eine Lücke. Ein Studienteam hat einen Weg gesucht, sie zu schließen.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.