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Fedullo AL, Messina M, Elia L, Piciocchi A, Gianfelici V, Lauretti A, Soddu S, Puzzolo MC, Minotti C, Ferrara F, Martino B, Chiusolo P, Calafiore V, Paolini S, Vignetti M, Vitale A, Guarini A, Foà R, Chiaretti S. Prognostic implications of additional genomic lesions in adult Philadelphia chromosome-positive acute lymphoblastic leukemia. Haematologica 2018; 104:312-318. [PMID: 30190342 PMCID: PMC6355475 DOI: 10.3324/haematol.2018.196055] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/30/2018] [Indexed: 12/30/2022] Open
Abstract
To shed light onto the molecular basis of Philadelphia chromosome-positive acute lymphoblastic leukemia and to investigate the prognostic role of additional genomic lesions, we analyzed copy number aberrations using the Cytoscan HD Array in 116 newly diagnosed adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia enrolled in four different GIMEMA protocols, all based on a chemotherapy-free induction strategy. This analysis showed that patients with Philadelphia chromosome-positive acute lymphoblastic leukemia carry an average of 7.8 lesions/case, with deletions outnumbering gains (88% versus 12%). The most common deletions were those targeting IKZF1, PAX5 and CDKN2A/B, which were detected in 84%, 36% and 32% of cases, respectively. Patients carrying simultaneous deletions of IKZF1 plus CDKN2A/B and/or PAX5 had a significantly lower disease-free survival rate (24.9% versus 43.3%; P=0.026). The only IKZF1 isoform affecting prognosis was the dominant negative one (P=0.003). Analysis of copy number aberrations showed that 18% of patients harbored MEF2C deletions, which were of two types, differing in size: the longer deletions were associated with the achievement of a complete molecular remission (P=0.05) and had a favorable impact on disease-free survival (64.3% versus 32.1% at 36 months; P=0.031). These findings retained statistical significance also in multivariate analysis (P=0.057). KRAS deletions, detected in 6% of cases, were associated with the achievement of a complete molecular remission (P=0.009). These results indicate that in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia a detailed evaluation of additional deletions - including CDKN2A/B, PAX5, IKZF1, MEF2C and KRAS - has prognostic implications and should be incorporated in the design of more personalized treatment strategies.
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Affiliation(s)
- Anna Lucia Fedullo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Monica Messina
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Loredana Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | | | - Valentina Gianfelici
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Alessia Lauretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | | | - Maria Cristina Puzzolo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Clara Minotti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria
| | | | | | - Stefania Paolini
- "L. and A. Seràgnoli" Institute of Hematology, University of Bologna
| | - Marco Vignetti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome.,GIMEMA Data Center, Rome
| | - Antonella Vitale
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
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