Genetic abnormalities in myelodysplasia and secondary acute myeloid leukemia: impact on outcome of stem cell transplantation

• Published in: Blood 2017-04, Vol.129 (17), p.2347-2358
• Main Authors: Yoshizato, Tetsuichi, Nannya, Yasuhito, Atsuta, Yoshiko, Shiozawa, Yusuke, Iijima-Yamashita, Yuka, Yoshida, Kenichi, Shiraishi, Yuichi, Suzuki, Hiromichi, Nagata, Yasunobu, Sato, Yusuke, Kakiuchi, Nobuyuki, Matsuo, Keitaro, Onizuka, Makoto, Kataoka, Keisuke, Chiba, Kenichi, Tanaka, Hiroko, Ueno, Hiroo, Nakagawa, Masahiro M., Przychodzen, Bartlomiej, Haferlach, Claudia, Kern, Wolfgang, Aoki, Kosuke, Itonaga, Hidehiro, Kanda, Yoshinobu, Sekeres, Mikkael A., Maciejewski, Jaroslaw P., Haferlach, Torsten, Miyazaki, Yasushi, Horibe, Keizo, Sanada, Masashi, Miyano, Satoru, Makishima, Hideki, Ogawa, Seishi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Chromosome Aberrations; Cohort Studies; DNA Copy Number Variations; Female; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells; High-Throughput Nucleotide Sequencing; Humans; Leukemia, Myeloid, Acute - etiology; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Middle Aged; Mutation; Myelodysplastic Syndromes - complications; Myelodysplastic Syndromes - genetics; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; Plenary Paper; Prognosis; Proportional Hazards Models; ras Proteins - genetics; ras Proteins - metabolism; Recurrence; Risk; Transplantation, Homologous; Treatment Outcome; Tumor Suppressor Protein p53 - genetics; Tumor Suppressor Protein p53 - metabolism
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2016-12-754796

Genetic alterations, including mutations and copy-number alterations, are central to the pathogenesis of myelodysplastic syndromes and related diseases (myelodysplasia), but their roles in allogeneic stem cell transplantation have not fully been studied in a large cohort of patients. We enrolled 797 patients who had been diagnosed with myelodysplasia at initial presentation and received transplantation via the Japan Marrow Donor Program. Targeted-capture sequencing was performed to identify mutations in 69 genes, together with copy-number alterations, whose effects on transplantation outcomes were investigated. We identified 1776 mutations and 927 abnormal copy segments among 617 patients (77.4%). In multivariate modeling using Cox proportional-hazards regression, genetic factors explained 30% of the total hazards for overall survival; clinical characteristics accounted for 70% of risk. TP53 and RAS-pathway mutations, together with complex karyotype (CK) as detected by conventional cytogenetics and/or sequencing-based analysis, negatively affected posttransplant survival independently of clinical factors. Regardless of disease subtype, TP53-mutated patients with CK were characterized by unique genetic features and associated with an extremely poor survival with frequent early relapse, whereas outcomes were substantially better in TP53-mutated patients without CK. By contrast, the effects of RAS-pathway mutations depended on disease subtype and were confined to myelodysplastic/myeloproliferative neoplasms (MDS/MPNs). Our results suggest that TP53 and RAS-pathway mutations predicted a dismal prognosis, when associated with CK and MDS/MPNs, respectively. However, for patients with mutated TP53 or CK alone, long-term survival could be obtained with transplantation. Clinical sequencing provides vital information for accurate prognostication in transplantation. •TP53 and RAS-pathway mutations predict very poor survival, when seen with CK and MDS/MPNs, respectively.•For patients with mutated TP53 or CK alone, long-term survival could be obtained with stem cell transplantation.