Mutation accumulation in cancer genes relates to nonoptimal outcome in chronic myeloid leukemia

• Published in: Blood advances 2020-02, Vol.4 (3), p.546-559
• Main Authors: Adnan Awad, Shady, Kankainen, Matti, Ojala, Teija, Koskenvesa, Perttu, Eldfors, Samuli, Ghimire, Bishwa, Kumar, Ashwini, Kytölä, Soili, Kamel, Mahmoud M., Heckman, Caroline A., Porkka, Kimmo, Mustjoki, Satu
• Format: Article
• Language: English
• Subjects: Blast Crisis; Fusion Proteins, bcr-abl - genetics; Genes, Neoplasm; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - genetics; Mutation Accumulation; Myeloid Neoplasia
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2019000943

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm accounting for ∼15% of all leukemia. Progress of the disease from an indolent chronic phase to the more aggressive accelerated phase or blast phase (BP) occurs in a minority of cases and is associated with an accumulation of somatic mutations. We performed genetic profiling of 85 samples and transcriptome profiling of 12 samples from 59 CML patients. We identified recurrent somatic mutations in ABL1 (37%), ASXL1 (26%), RUNX1 (16%), and BCOR (16%) in the BP and observed that mutation signatures in the BP resembled those of acute myeloid leukemia (AML). We found that mutation load differed between the indolent and aggressive phases and that nonoptimal responders had more nonsilent mutations than did optimal responders at the time of diagnosis, as well as in follow-up. Using RNA sequencing, we identified other than BCR-ABL1 cancer-associated hybrid genes in 6 of the 7 BP samples. Uncovered expression alterations were in turn associated with mechanisms and pathways that could be targeted in CML management and by which somatic alterations may emerge in CML. Last, we showed the value of genetic data in CML management in a personalized medicine setting. •High mutational load and variants in cancer genes predicts nonoptimal treatment outcome and are new independent prognostic markers of CML.•Dysregulation of DNA repair and the JAK-STAT signaling pathways relates to progression. [Display omitted]