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靶向 RNA 测序在急性髓系白血病 KMT2A-部分串联重复识别中的应用及分子特征的综合分析。

The Application of Targeted RNA Sequencing for KMT2A-Partial Tandem Duplication Identification and Integrated Analysis of Molecular Characterization in Acute Myeloid Leukemia.

机构信息

Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Jiangsu Key Laboratory of Zoonosis and Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonose, Yangzhou University, Yangzhou, China.

出版信息

J Mol Diagn. 2021 Nov;23(11):1478-1490. doi: 10.1016/j.jmoldx.2021.07.019. Epub 2021 Aug 10.

Abstract

The partial tandem duplication of histone-lysine N-methyltransferase 2A (KMT2A-PTD) is an important genetic alteration in acute myeloid leukemia (AML) and is associated with poor clinical outcome. Accurate and rapid detection of KMT2A-PTD is important for outcome prediction and clinical management, but next-generation sequencing-based quantitative research is still lacking. In this study, we developed a targeted RNA-based next-generation sequencing panel, together with single primer enrichment and unique molecular identifiers, to identify KMT2A-PTD as well as AML-related gene fusions and other driver mutations. Our panel showed high sensitivity, accuracy, and reproducibility in detecting the fusion ratio of KMT2A-PTD. The mutation profile of KMT2A-PTD-positive patients with AML was characterized and different distribution patterns of driver mutations were found according to KMT2A-PTD fusion ratio level. Survival analyses revealed that the fusion ratio of KMT2A-PTD did not affect clinical outcome, but a novel molecular combination, namely, KMT2A-PTD/DNMT3A/FMS-like tyrosine kinase 3-internal tandem duplication, was associated with poor prognosis. Finally, it was shown that the dynamic changes in the KMT2A-PTD fusion ratio were consistent with the overall process of disease progression. In summary, we applied the unique molecular identifier-based RNA panel to quantitatively detect KMT2A-PTD and elucidate its clinical relevance, which complemented the integrative network of various genetic alterations in AML.

摘要

组蛋白赖氨酸 N-甲基转移酶 2A(KMT2A-PTD)部分串联重复是急性髓系白血病(AML)中的重要遗传改变,与不良临床结局相关。准确、快速地检测 KMT2A-PTD 对于预后预测和临床管理很重要,但基于下一代测序的定量研究仍然缺乏。在本研究中,我们开发了一种靶向 RNA 下一代测序 panel,结合单引物富集和独特分子标识符,用于鉴定 KMT2A-PTD 以及 AML 相关基因融合和其他驱动突变。我们的 panel 在检测 KMT2A-PTD 融合比方面显示出高灵敏度、准确性和重现性。我们对 KMT2A-PTD 阳性 AML 患者的突变谱进行了特征描述,并根据 KMT2A-PTD 融合比水平发现了不同的驱动突变分布模式。生存分析表明,KMT2A-PTD 的融合比并不影响临床结局,但一种新的分子组合,即 KMT2A-PTD/DNMT3A/FMS 样酪氨酸激酶 3 内部串联重复,与不良预后相关。最后,结果表明 KMT2A-PTD 融合比的动态变化与疾病进展的整体过程一致。总之,我们应用基于独特分子标识符的 RNA panel 定量检测 KMT2A-PTD,并阐明其临床相关性,这补充了 AML 中各种遗传改变的综合网络。

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