Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.
Division of Health Care Sciences, Dresden International University, Dresden, Germany.
Blood Cancer J. 2023 Jan 24;13(1):18. doi: 10.1038/s41408-023-00790-1.
Functional perturbations of the cohesin complex with subsequent changes in chromatin structure and replication are reported in a multitude of cancers including acute myeloid leukemia (AML). Mutations of its STAG2 subunit may predict unfavorable risk as recognized by the 2022 European Leukemia Net recommendations, but the underlying evidence is limited by small sample sizes and conflicting observations regarding clinical outcomes, as well as scarce information on other cohesion complex subunits. We retrospectively analyzed data from a multi-center cohort of 1615 intensively treated AML patients and identified distinct co-mutational patters for mutations of STAG2, which were associated with normal karyotypes (NK) and concomitant mutations in IDH2, RUNX1, BCOR, ASXL1, and SRSF2. Mutated RAD21 was associated with NK, mutated EZH2, KRAS, CBL, and NPM1. Patients harboring mutated STAG2 were older and presented with decreased white blood cell, bone marrow and peripheral blood blast counts. Overall, neither mutated STAG2, RAD21, SMC1A nor SMC3 displayed any significant, independent effect on clinical outcomes defined as complete remission, event-free, relapse-free or overall survival. However, we found almost complete mutual exclusivity of genetic alterations of individual cohesin subunits. This mutual exclusivity may be the basis for therapeutic strategies via synthetic lethality in cohesin mutated AML.
功能失调的黏合复合物与随后的染色质结构和复制变化在许多癌症中都有报道,包括急性髓系白血病(AML)。其 STAG2 亚基的突变可能预示着不良风险,这被 2022 年欧洲白血病网络的建议所认可,但潜在的证据受到样本量小和对临床结果的观察结果相互矛盾的限制,以及关于其他黏合复合物亚基的信息稀缺。我们对 1615 例强化治疗 AML 患者的多中心队列进行了回顾性数据分析,并确定了 STAG2 突变的独特共突变模式,其与正常核型(NK)和 IDH2、RUNX1、BCOR、ASXL1 和 SRSF2 同时突变相关。RAD21 突变与 NK、EZH2、KRAS、CBL 和 NPM1 突变相关。携带 STAG2 突变的患者年龄较大,且白细胞、骨髓和外周血原始细胞计数减少。总体而言,突变的 STAG2、RAD21、SMC1A 和 SMC3 均未对完全缓解、无事件、无复发或总生存等临床结果产生任何显著的独立影响。然而,我们发现单个黏合复合物亚基的遗传改变几乎完全相互排斥。这种相互排斥性可能是黏合复合物突变 AML 通过合成致死性进行治疗策略的基础。
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