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IDENTIFICATIONS OF NOVEL RECURRENT PU.1 FUSIONS WITH HIGHLY AGGRESSIVE PHENOTYPE IN PEDIATRIC T CELL ACUTE LYMPHOBLASTIC LEUKEMIA
Author(s): ,
Masafumi Seki
Affiliations:
Department of Pediatrics,The University of Tokyo Hospital,Tokyo,Japan
,
Shunsuke Kimura
Affiliations:
Department of Pediatrics, Hiroshima University,Hiroshima,Japan
,
Tomoya Isobe
Affiliations:
Department of Pediatrics,The University of Tokyo Hospital,Tokyo,Japan
,
Kenichi Yoshida
Affiliations:
Department of Pathology and Tumor Biology,Graduate School of Medicine, Kyoto University,Kyoto,Japan
,
Hiroo Ueno
Affiliations:
Department of Pathology and Tumor Biology,Graduate School of Medicine, Kyoto University,Kyoto,Japan
,
Hiromichi Suzuki
Affiliations:
Department of Pathology and Tumor Biology,Graduate School of Medicine, Kyoto University,Kyoto,Japan
,
Yusuke Shiozawa
Affiliations:
Department of Pediatrics,The University of Tokyo Hospital,Tokyo,Japan
,
Keisuke Kataoka
Affiliations:
Department of Pathology and Tumor Biology,Graduate School of Medicine, Kyoto University,Kyoto,Japan
,
Yoichi Fujii
Affiliations:
Department of Pathology and Tumor Biology,Graduate School of Medicine, Kyoto University,Kyoto,Japan
,
Yuichi Shiraishi
Affiliations:
Laboratory of DNA Information Analysis,Human Genome Center, Institute of Medical Science, The University of Tokyo,Tokyo,Japan
,
Kenichi Chiba
Affiliations:
Laboratory of DNA Information Analysis,Human Genome Center, Institute of Medical Science, The University of Tokyo,Tokyo,Japan
,
Hiroko Tanaka
Affiliations:
Laboratory of DNA Information Analysis,Human Genome Center, Institute of Medical Science, The University of Tokyo,Tokyo,Japan
,
Teppei Shimamura
Affiliations:
Division of Systems Biology,Nagoya University Graduate School of Medicine,Nagoya,Japan
,
Lin Lin
Affiliations:
Department of Pediatrics and Developmental Biology,Tokyo Medical and Dental University,Tokyo,Japan
,
Masatoshi Takagi
Affiliations:
Department of Pediatrics and Developmental Biology,Tokyo Medical and Dental University,Tokyo,Japan
,
Changshan Wang
Affiliations:
Department of Cellular and Molecular Medicine,Graduate School of Medicine, Chiba University,Chiba,Japan
,
Atsushi Iwama
Affiliations:
Department of Cellular and Molecular Medicine,Graduate School of Medicine, Chiba University,Chiba,Japan
,
Kentaro Ohki
Affiliations:
Department of Pediatric Hematology and Oncology Research,National Research Institute for Child Health and Development,Tokyo,Japan
,
Motohiro Kato
Affiliations:
Department of Pediatric Hematology and Oncology Research,National Research Institute for Child Health and Development,Tokyo,Japan
,
Yuki Arakawa
Affiliations:
Department of Hematology/Oncology,Saitama Children's Medical Center,Saitama,Japan
,
Katsuyoshi Koh
Affiliations:
Department of Hematology/Oncology,Saitama Children's Medical Center,Saitama,Japan
,
Ryoji Hanada
Affiliations:
Department of Hematology/Oncology,Saitama Children's Medical Center,Saitama,Japan
,
Hiroshi Moritake
Affiliations:
Division of Pediatrics, Faculty of Medicine,University of Miyazaki,Miyazaki,Japan
,
Masaharu Akiyama
Affiliations:
Department of Pediatrics,The Jikei University School of Medicine,Tokyo,Japan
,
Ryoji Kobayashi
Affiliations:
Department of Pediatrics,Sapporo Hokuyu Hospital,Sapporo,Japan
,
Takao Deguchi
Affiliations:
Department of Pediatrics,Mie University Graduate School of Medicine,Tsu,Japan
,
Yoshiko Hashii
Affiliations:
Department of Pediatrics,Osaka University Graduate School of Medicine,Suita,Japan
,
Toshihiko Imamura
Affiliations:
Department of Pediatrics,Kyoto Prefectural University of Medicine, Graduate School of Medical Science,Kyoto,Japan
,
Atsushi Sato
Affiliations:
Department of Hematology and Oncology,Miyagi Children's Hospital,Sendai,Japan
,
Nobutaka Kiyokawa
Affiliations:
Department of Pediatric Hematology and Oncology Research,National Research Institute for Child Health and Development,Tokyo,Japan
,
Akira Oka
Affiliations:
Department of Pediatrics,The University of Tokyo Hospital,Tokyo,Japan
,
Yasuhide Hayashi
Affiliations:
Gunma Children's Medical Center,Shibukawa,Japan
,
Atsushi Manabe
Affiliations:
Department of Pediatrics,St. Luke's International Hospital,Tokyo,Japan
,
Akira Ohara
Affiliations:
Department of Pediatrics,Toho University,Tokyo,Japan
,
Keizo Horibe
Affiliations:
Clinical Research Center,National Hospital Organization Nagoya Medical Center,Nagoya,Japan
,
Masashi Sanada
Affiliations:
Clinical Research Center,National Hospital Organization Nagoya Medical Center,Nagoya,Japan
,
Hiroyuki Mano
Affiliations:
Department of Cellular Signaling,Graduate School of Medicine, The University of Tokyo,Tokyo,Japan
,
Satoru Miyano
Affiliations:
Laboratory of DNA Information Analysis,Human Genome Center, Institute of Medical Science, The University of Tokyo,Tokyo,Japan
,
Seishi Ogawa
Affiliations:
Department of Pathology and Tumor Biology,Graduate School of Medicine, Kyoto University,Kyoto,Japan
Junko Takita
Affiliations:
Department of Pediatrics,The University of Tokyo Hospital,Tokyo,Japan
(Abstract release date: 05/18/17) EHA Library. Seki M. 06/25/17; 182086; S799
Masafumi Seki
Masafumi Seki
Contributions
Abstract

Abstract: S799

Type: Oral Presentation

Presentation during EHA22: On Sunday, June 25, 2017 from 08:00 - 08:15

Location: Room N103

Background
T-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL), arising from the malignant transformation of hematopoietic progenitors primed toward T cell development, as result of a multistep oncogenic process. However, since the prognostic significance of these genetic alterations in pediatric T-ALL is not clear, genetic basis which contributes aggressive phenotype or progression of pediatric T-ALL is still to be elucidated.

Aims
To discover driver genetic events, which involved in the aggressive phenotype of pediatric T-ALL and to identify its novel prognostic markers, we performed integrated genetic analysis in a large cohort of T-ALL case.

Methods
Our cohorts included samples from Tokyo Children’s Cancer Study Group (TCCSG) and Japan Association of Childhood Leukemia Study (JACLS). Whole transcriptome sequencing (WTS) was performed in 123 cases. Whole transcriptome sequencing (WTS) was performed in 123 cases.

Results
Representative recurrent fusion genes were as follows, SIL-TAL1 (n=25), MLL-ENL (n=5), PICALM-MLLT10 (n=5), and NUP214-ABL1 (n=2). Intriguingly, novel recurrent in-frame PU.1 fusions (STMN1-PU.1 n=2; TCF7-PU.1 n=5) were detected, and RT-PCR analysis in additional 60 cases revealed other 2 TCF7-PU.1 fusions. Thus, PU.1 fusions accounted for 4% of pediatric T-ALL/LBL. Expression data of WTS revealed cases with PU.1 fusion showed significantly higher expression of PU.1 compared to cases without PU.1 fusion, implicating that aberrant high expression of PU.1 involved in leukemogenesis.

Using consecutive two-step unsupervised consensus clustering, we obtained 5 stable clusters.  Among these, 4 clusters largely recapitulated distinct T-ALL subtypes characterized in previous studies by an early T-cell precursor (ETP) signature (ETP-ALL), 2 clusters of high TAL1 expression (TAL1-RA and -RB -ALL), and mutually exclusive expression of, TLX1, and TLX3 (TLX-related-ALL). However, the remaining one was newly identified and exclusively consisted of the 7 PU.1 fusion-positive cases. Compared to ETP-ALL, these PU.1 fusion cases typically showed a reduced expression of the phase I genes implicated in early T-cell development, except for PU.1, which was ectopically up-regulated by the relevant gene fusions. All cases with PU.1 fusion were grouped into PU.1 high cluster. Moreover, PU.1 high cluster had distinct genetic features with mutations of transcription factors, such as GATA3, RUNX1, and EVT6. Of note, significant poor outcome was confirmed by multivariate analysis in cases with PU.1 high cluster (p = 0.048). Consistently, we defined PU.1 overexpression cases as outliers of PU.1 expression, which resulting in extremely poor prognosis (3-year OS 21%, log-rank p = 6.9 ×10-7).

Conclusion
PU.1 fusions expressing cells expanded and they remained at an immature stage, implicating a potential leukemogenic activity of these fusions. Not only the cases with PU.1 fusions, but also the cases with high PU.1 expression without fusions showed extremely poor prognosis, suggesting the prognostic value of aberrant PU.1 expression in pediatric T-ALL. Although it remains unclear, why cases with PU.1 fusions/high PU.1 expression have a poor prognosis, our results indicate that these cases are genetically distinct subgroup from other pediatric T-ALL.

Session topic: 1. Acute lymphoblastic leukemia - Biology

Keyword(s): T cell acute lymphoblastic leukemia, Pediatric

Abstract: S799

Type: Oral Presentation

Presentation during EHA22: On Sunday, June 25, 2017 from 08:00 - 08:15

Location: Room N103

Background
T-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL), arising from the malignant transformation of hematopoietic progenitors primed toward T cell development, as result of a multistep oncogenic process. However, since the prognostic significance of these genetic alterations in pediatric T-ALL is not clear, genetic basis which contributes aggressive phenotype or progression of pediatric T-ALL is still to be elucidated.

Aims
To discover driver genetic events, which involved in the aggressive phenotype of pediatric T-ALL and to identify its novel prognostic markers, we performed integrated genetic analysis in a large cohort of T-ALL case.

Methods
Our cohorts included samples from Tokyo Children’s Cancer Study Group (TCCSG) and Japan Association of Childhood Leukemia Study (JACLS). Whole transcriptome sequencing (WTS) was performed in 123 cases. Whole transcriptome sequencing (WTS) was performed in 123 cases.

Results
Representative recurrent fusion genes were as follows, SIL-TAL1 (n=25), MLL-ENL (n=5), PICALM-MLLT10 (n=5), and NUP214-ABL1 (n=2). Intriguingly, novel recurrent in-frame PU.1 fusions (STMN1-PU.1 n=2; TCF7-PU.1 n=5) were detected, and RT-PCR analysis in additional 60 cases revealed other 2 TCF7-PU.1 fusions. Thus, PU.1 fusions accounted for 4% of pediatric T-ALL/LBL. Expression data of WTS revealed cases with PU.1 fusion showed significantly higher expression of PU.1 compared to cases without PU.1 fusion, implicating that aberrant high expression of PU.1 involved in leukemogenesis.

Using consecutive two-step unsupervised consensus clustering, we obtained 5 stable clusters.  Among these, 4 clusters largely recapitulated distinct T-ALL subtypes characterized in previous studies by an early T-cell precursor (ETP) signature (ETP-ALL), 2 clusters of high TAL1 expression (TAL1-RA and -RB -ALL), and mutually exclusive expression of, TLX1, and TLX3 (TLX-related-ALL). However, the remaining one was newly identified and exclusively consisted of the 7 PU.1 fusion-positive cases. Compared to ETP-ALL, these PU.1 fusion cases typically showed a reduced expression of the phase I genes implicated in early T-cell development, except for PU.1, which was ectopically up-regulated by the relevant gene fusions. All cases with PU.1 fusion were grouped into PU.1 high cluster. Moreover, PU.1 high cluster had distinct genetic features with mutations of transcription factors, such as GATA3, RUNX1, and EVT6. Of note, significant poor outcome was confirmed by multivariate analysis in cases with PU.1 high cluster (p = 0.048). Consistently, we defined PU.1 overexpression cases as outliers of PU.1 expression, which resulting in extremely poor prognosis (3-year OS 21%, log-rank p = 6.9 ×10-7).

Conclusion
PU.1 fusions expressing cells expanded and they remained at an immature stage, implicating a potential leukemogenic activity of these fusions. Not only the cases with PU.1 fusions, but also the cases with high PU.1 expression without fusions showed extremely poor prognosis, suggesting the prognostic value of aberrant PU.1 expression in pediatric T-ALL. Although it remains unclear, why cases with PU.1 fusions/high PU.1 expression have a poor prognosis, our results indicate that these cases are genetically distinct subgroup from other pediatric T-ALL.

Session topic: 1. Acute lymphoblastic leukemia - Biology

Keyword(s): T cell acute lymphoblastic leukemia, Pediatric

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