分析非白血病细胞亚群重建急性髓系白血病的克隆进化,并鉴定出耐药性白血病前克隆。

Analysis of nonleukemic cellular subcompartments reconstructs clonal evolution of acute myeloid leukemia and identifies therapy-resistant preleukemic clones.

机构信息

Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.

German Cancer Research Center (DKFZ), Heidelberg, Germany.

出版信息

Int J Cancer. 2021 Jun 1;148(11):2825-2838. doi: 10.1002/ijc.33461. Epub 2021 Jan 18.

Abstract

To acquire a better understanding of clonal evolution of acute myeloid leukemia (AML) and to identify the clone(s) responsible for disease recurrence, we have comparatively studied leukemia-specific mutations by whole-exome-sequencing (WES) of both the leukemia and the nonleukemia compartments derived from the bone marrow of AML patients. The T-lymphocytes, B-lymphocytes and the functionally normal hematopoietic stem cells (HSC), that is, CD34 /CD38 /ALDH cells for AML with rare-ALDH blasts (<1.9% ALDH cells) were defined as the nonleukemia compartments. WES identified 62 point-mutations in the leukemia compartment derived from 12 AML-patients at the time of diagnosis and 73 mutations in 3 matched relapse cases. Most patients (8/12) showed 4 to 6 point-mutations per sample at diagnosis. Other than the mutations in the recurrently mutated genes such as DNMT3A, NRAS and KIT, we were able to identify novel point-mutations that have not yet been described in AML. Some leukemia-specific mutations and cytogenetic abnormalities including DNMT3A(R882H), EZH2(I146T) and inversion(16) were also detectable in the respective T-lymphocytes, B-lymphocytes and HSC in 5/12 patients, suggesting that preleukemia HSC might represent the source of leukemogenesis for these cases. The leukemic evolution was reconstructed for five cases with detectable preleukemia clones, which were tracked in follow-up and relapse samples. Four of the five patients with detectable preleukemic mutations developed relapse. The presence of leukemia-specific mutations in these nonleukemia compartments, especially after chemotherapy or after allogeneic stem cell transplantation, is highly relevant, as these could be responsible for relapse. This discovery may facilitate the identification of novel targets for long-term cure.

摘要

为了更好地了解急性髓系白血病(AML)的克隆进化,并确定导致疾病复发的克隆,我们通过对来自 AML 患者骨髓的白血病和非白血病区室进行全外显子组测序(WES),比较研究了白血病特异性突变。将 T 淋巴细胞、B 淋巴细胞和功能正常的造血干细胞(HSC),即 AML 中罕见 ALDH blasts(<1.9%ALDH 细胞)的 CD34/CD38/ALDH 细胞,定义为非白血病区室。WES 在 12 名 AML 患者初诊时的白血病区室中鉴定出 62 个点突变,在 3 个匹配的复发病例中鉴定出 73 个突变。大多数患者(8/12)在初诊时每个样本显示 4 至 6 个点突变。除了在复发性突变基因(如 DNMT3A、NRAS 和 KIT)中发现的突变外,我们还能够鉴定出尚未在 AML 中描述的新的点突变。在 5/12 名患者中,也可以在各自的 T 淋巴细胞、B 淋巴细胞和 HSC 中检测到白血病特异性突变和细胞遗传学异常,包括 DNMT3A(R882H)、EZH2(I146T)和倒位(16),提示前白血病 HSC 可能代表这些病例的白血病发生源。对五个可检测到前白血病克隆的病例进行了白血病进化重建,这些克隆在随访和复发样本中进行了跟踪。在五个可检测到前白血病突变的患者中有四个出现复发。这些非白血病区室中存在白血病特异性突变,尤其是在化疗后或异基因干细胞移植后,这与复发高度相关,因为这些突变可能是导致复发的原因。这一发现可能有助于确定长期治愈的新靶点。

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