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Barrio S, Shanafelt TD, Ojha J, Chaffee KG, Secreto C, Kortüm KM, Pathangey S, Van-Dyke DL, Slager SL, Fonseca R, Kay NE, Braggio E. Genomic characterization of high-count MBL cases indicates that early detection of driver mutations and subclonal expansion are predictors of adverse clinical outcome. Leukemia 2016; 31:170-176. [PMID: 27469216 PMCID: PMC5215040 DOI: 10.1038/leu.2016.172] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 12/21/2022]
Abstract
High-count monoclonal B-cell lymphocytosis (MBL) is an asymptomatic expansion of clonal B-cells in the peripheral blood without other manifestations of chronic lymphocytic leukemia (CLL). Yearly, 1% of MBLs evolve to CLL requiring therapy; thus being critical to understand the biologic events that determine which MBLs progress to intermediate/advanced CLL. In this study, we performed targeted deep-sequencing on 48 high-count MBLs, 47 of them with 2-4 sequential samples analyzed, exploring the mutation status of 21 driver genes and evaluating clonal evolution. We found somatic non-synonymous mutations in 25 MBLs(52%) at the initial time-point analyzed, including 13(27%) with >1 mutated gene. In cases that subsequently progressed to CLL, mutations were detected 41 months (median) prior to progression. Excepting NOTCH1, TP53 and XPO1, which showed a lower incidence in MBL, genes were mutated with a similar prevalence to CLL, indicating the early origin of most driver mutations in the MBL/CLL continuum. MBLs with mutations at the initial time-point analyzed were associated with shorter time-to-treatment (TTT). Furthermore, MBLs showing subclonal expansion of driver mutations on sequential evaluation had shorter progression time to CLL and shorter TTT. These findings support that clonal evolution have prognostic implications already at the pre-malignant MBL stage, anticipating which individuals will progress earlier to CLL.
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Affiliation(s)
- S Barrio
- Department of Hematology, Mayo Clinic, Scottsdale, AZ, USA
| | - T D Shanafelt
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Ojha
- Department of Hematology, Mayo Clinic, Scottsdale, AZ, USA
| | - K G Chaffee
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - C Secreto
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K M Kortüm
- Department of Hematology, Mayo Clinic, Scottsdale, AZ, USA.,Department of Hematology, University Hospital, Würzburg, Germany
| | - S Pathangey
- Department of Hematology, Mayo Clinic, Scottsdale, AZ, USA
| | - D L Van-Dyke
- Laboratory of Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - R Fonseca
- Department of Hematology, Mayo Clinic, Scottsdale, AZ, USA
| | - N E Kay
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - E Braggio
- Department of Hematology, Mayo Clinic, Scottsdale, AZ, USA
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