Adult low hypodiploid acute lymphoblastic leukemia emerges from pre-leukemic TP53-mutant clonal hematopoiesis
Blood Cancer Discovery, January 2023
Rathana Kim, Hugo Bergugnat, Lise Larcher, Matthieu Duchmann, Marie Passet, Stephanie Gachet, Wendy Cuccuini, Marina Lafage-Pochitaloff, Cedric Pastoret, Nathalie Grardel, Vahid Asnafi, Beat W. Schafer, Eric Delabesse, Raphael Itzykson, Lionel Ades, Yosr Hicheri, Yves Chalandon, Carlos Graux, Patrice Chevallier, Mathilde Hunault, Thibaut Leguay, Francoise Huguet, Veronique Lheritier, Herve Dombret, Jean Soulier, PHILIPPE ROUSSELOT, Nicolas Boissel, Emmanuelle Clappier
Low hypodiploidy defines a rare subtype of B-cell acute lymphoblastic leukemia (B-ALL) with a dismal outcome. To investigate the genomic basis of low-hypodiploid ALL (LH-ALL) in adults, we analyzed copy-number aberrations, loss-of-heterozygosity, mutations and cytogenetics data in a prospective cohort of Philadelphia-negative B-ALL patients (n=591, aged 18-84y), allowing to identify 80 LH-ALL cases (14%). Genomic analysis was critical for evidencing low hypodiploidy in many cases missed by cytogenetics. The proportion of LH-ALL dramatically increased with age, from 3% below the age of 40 to 32% over 55 years. Somatic TP53 biallelic inactivation was the hallmark of adult LH-ALL, present in virtually all cases (98%). Strikingly, we detected TP53 mutations in post-treatment remission samples in 34% of patients. Single-cell proteogenomics of diagnosis and remission bone marrow samples evidenced a preleukemic, multilineage, TP53-mutant clone, reminiscent of age-related clonal hematopoiesis.
|Members of the public||11||52%|
|Science communicators (journalists, bloggers, editors)||2||10%|
|Practitioners (doctors, other healthcare professionals)||2||10%|