分支克隆进化模式在多发性骨髓瘤的突变图谱中占主导地位。

Branching clonal evolution patterns predominate mutational landscape in multiple myeloma.

作者信息

Farswan Akanksha, Jena Lingaraja, Kaur Gurvinder, Gupta Anubha, Gupta Ritu, Rani Lata, Sharma Atul, Kumar Lalit

机构信息

SBILab, Department of Electronics and Communication Engineering, Indraprastha Institute of Information Technology-Delhi (IIIT-D) Delhi 110020, India.

Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS) New Delhi 110029, India.

出版信息

Am J Cancer Res. 2021 Nov 15;11(11):5659-5679. eCollection 2021.

DOI:
Abstract

Multiple Myeloma (MM) arises from malignant transformation and deregulated proliferation of clonal plasma cells (PCs) harbouring heterogeneous molecular anomalies. The effect of evolving mutations on clone fitness and their cellular prevalence shapes the progressing myeloma genome and impacts clinical outcomes. Although clonal heterogeneity in MM is well established, which subclonal mutations emerge/persist/perish with progression in MM and which of these can be targeted therapeutically remains an open question. In line with this, we have sequenced pairwise whole exomes of 62 MM patients collected at two time points, i.e., at diagnosis and on progression. Somatic variants were called using a novel ensemble approach where a consensus was deduced from four variant callers (Illumina's Dragen, Strelka2, SomaticSniper and SpeedSeq) and actionable/druggable gene targets were identified. A marked intraclonal heterogeneity was observed. Branching evolution was observed among 72.58% patients, of whom 64.51% had low TMBs (<10) and 61.29% had 2 or more founder clones. The hypermutator patients (with high TMB levels ≥10 to ≤100) showed a significant decrease in their TMBs from diagnosis (median TMB 77.11) to progression (median TMB 31.22). A distinct temporal fall in subclonal driver mutations was identified recurrently across diagnosis to progression e.g., in and genes in 3 or more patients suggesting such patients could be treated early with target specific drugs like Vemurafenib/Cobimetinib. An analogous rise in driver mutations was observed in and other genes. A few drivers such as and retained consistent distribution patterns at two time points. These findings are clinically relevant and point at consideration of evaluating multi time point subclonal mutational landscapes for designing better risk stratification strategies and tailoring time to time risk adapted combination therapies in future.

摘要

多发性骨髓瘤(MM)源于具有异质性分子异常的克隆性浆细胞(PC)的恶性转化和增殖失调。不断演变的突变对克隆适应性及其细胞流行率的影响塑造了进展性骨髓瘤基因组并影响临床结果。尽管MM中的克隆异质性已得到充分证实,但哪些亚克隆突变在MM进展过程中出现/持续/消失,以及其中哪些可以作为治疗靶点仍是一个悬而未决的问题。与此一致,我们对62例MM患者在两个时间点(即诊断时和进展时)收集的成对全外显子组进行了测序。使用一种新的整合方法来调用体细胞变异,该方法从四个变异调用程序(Illumina的Dragen、Strelka2、SomaticSniper和SpeedSeq)中推导得出共识,并确定可操作/可靶向治疗基因靶点。观察到明显的克隆内异质性。在72.58%的患者中观察到分支进化,其中64.51%的患者肿瘤突变负荷(TMB)较低(<10),61.29%的患者有2个或更多的起始克隆。高突变患者(TMB水平高,≥10至≤100)从诊断时(中位TMB 77.11)到进展时(中位TMB 31.22)TMB显著下降。在从诊断到进展的过程中反复发现亚克隆驱动突变有明显的时间下降,例如,在3例或更多患者的 和 基因中,这表明此类患者可以早期使用维莫非尼/考比替尼等靶向特异性药物进行治疗。在 和其他基因中观察到驱动突变有类似的增加。一些驱动基因,如 和 ,在两个时间点保持一致的分布模式。这些发现具有临床相关性,表明未来在设计更好的风险分层策略和适时调整风险适应性联合治疗方案时,应考虑评估多时间点亚克隆突变图谱。

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