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González-Gil C, Morgades M, Lopes T, Fuster-Tormo F, García-Chica J, Zhao R, Montesinos P, Torrent A, Diaz-Beya M, Coll R, Hermosín L, Mercadal S, González-Campos J, Zamora L, Artola T, Vall-Llovera F, Tormo M, Gil-Cortés C, Barba P, Novo A, Ribera J, Bernal T, De Ugarriza PL, Queipo MP, Martínez-Sánchez P, Giménez A, González-Martínez T, Cladera A, Cervera J, Fernández-Martín R, Ardaiz MÁ, Vidal MJ, Baena Á, López-Bigas N, Bigas A, Maciejewski J, Orfao A, Ribera JM, Genescà E. Genomics improves risk stratification of adults with T-cell acute lymphoblastic leukemia patients enrolled in measurable residual disease-oriented trials. Haematologica 2022; 108:969-980. [PMID: 36325893 PMCID: PMC10071117 DOI: 10.3324/haematol.2022.281196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Genetic information has been crucial to understand the pathogenesis of T-cell acute lymphoblastic leukemia (T-ALL) at diagnosis and at relapse, but still nowadays has a limited value in a clinical context. Few genetic markers are associated with the outcome of T-ALL patients, independently of measurable residual disease (MRD) status after therapy. In addition, the prognostic relevance of genetic features may be modulated by the specific treatment used. We analyzed the genetic profile of 145 T-ALL patients by targeted deep sequencing. Genomic information was integrated with the clinical-biological and survival data of a subset of 116 adult patients enrolled in two consecutive MRD-oriented trials of the Spanish PETHEMA (Programa Español de Tratamientos en Hematología) group. Genetic analysis revealed a mutational profile defined by DNMT3A/ N/KRAS/ MSH2/ U2AF1 gene mutations that identified refractory/resistant patients. Mutations in the DMNT3A gene were also found in the nonleukemic cell fraction of patients with T-ALL, revealing a possible mutational-driven clonal hematopoiesis event to prime T-ALL in elderly. The prognostic impact of this adverse genetic profile was independent of MRD status on day +35 of induction therapy. The combined WOG signature and MRD on day +35 allowed risk-stratification of T-ALL into standard or high-risk groups with significantly different 5-year overall survival (OS) (95% confidence interval [CI]) of 52% (37-67 %) and 17% (1-33%), respectively. These results confirm the relevance of the tumor genetic profile in predicting patient outcome in adult T-ALL and highlight the need for novel gene-targeted chemotherapeutic schedules to improve the OS of poor-prognosis T-ALL patients.
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Affiliation(s)
- Celia González-Gil
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Mireia Morgades
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Thaysa Lopes
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Francisco Fuster-Tormo
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Jesús García-Chica
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Ran Zhao
- Department of Quantitative Health Sciences and Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Anna Torrent
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Marina Diaz-Beya
- Servei d'Hematologia Clínica, Hospital Clínic de Barcelona, Barcelona
| | - Rosa Coll
- Institut Català d'Oncologia (ICO), Hospital Josep Trueta, Girona
| | - Lourdes Hermosín
- Servicio Hematología Clínica, Hospital de Jerez, Jerez de la Frontera
| | - Santiago Mercadal
- Servei d'Hematologia Clínica, Hospital Duran i Reynals-ICO, Hospitalet del Llobregat
| | | | - Lurdes Zamora
- Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Teresa Artola
- Servicio Hematología Clínica, Hospital Universitario de Donostia, Donostia
| | | | - Mar Tormo
- Hospital Clínico Universitario, Instituto de investigación INCLIVA, Valencia
| | | | - Pere Barba
- Servicio Hematología Clínica, Hospital Universitari de la Vall d'Hebron, Barcelona
| | - Andrés Novo
- Servicio Hematología Clínica, Hospital Son Espases, Palma de Mallorca
| | - Jordi Ribera
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Teresa Bernal
- Servicio Hematología Clínica, Hospital Central de Asturias, Instituto de Investigación Sanitario del Principado de Asturias (ISPA), Instituto Oncológico Universitario del Principado de Asturias (IUOPA), Oviedo
| | - Paula López De Ugarriza
- Servicio Hematología Clínica, Hospital Central de Asturias, Instituto de Investigación Sanitario del Principado de Asturias (ISPA), Instituto Oncológico Universitario del Principado de Asturias (IUOPA), Oviedo
| | - María-Paz Queipo
- Servicio Hematología Clínica, Hospital Virgen de la Victoria, Málaga
| | | | - Alicia Giménez
- Servicio Hematología Clínica, Hospital 12 de Octubre, Madrid
| | | | - Antonia Cladera
- Servicio Hematología Clínica, Hospital Son LLátzer, Palma de Mallorca
| | - José Cervera
- Hospital Universitari i Politècnic La Fe, Valencia
| | - Rosa Fernández-Martín
- Servicio Hematología Clínica, Hospital Insular de Gran Canarias, Las Palmas de Gran Canaria
| | | | | | - Ángela Baena
- Servicio Hematología Clínica, Complejo Hospitalario de Jaén, Jaén
| | - Nuria López-Bigas
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology, Barcelona
| | - Anna Bigas
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Program in Cancer Research, Institut-Hospital del Mar d'Investigacions Mèdiques, CIBERONC, Barcelona
| | - Jaroslaw Maciejewski
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Alberto Orfao
- Centro de Investigación del Cáncer (IBMCC-CSIC/USAL), Departamento de Medicina, Universidad de Salamanca, Instituto Biosanitario de Salamanca, CIBERONC, Salamanca
| | - Josep Maria Ribera
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Departament d'Hematologia Clínica, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Eulalia Genescà
- Institut d'Investigació contra la Leucemia Josep Carreras (IJC), Campus ICO-Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona.
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