Détection of genetic abnormalities in T-ALL : from biology to the clinic

Les leucémies aiguës lymphoblastiques T (LAL-T) sont caractérisées par la prolifération maligneincontrôlée de précurseurs lymphoïdes T bloqués dans la différenciation. Les stades d’arrêt dematuration observés dans les LAL-T reproduisent fidèlement les différentes étapes de la maturationthymique humaine. Ainsi nous avons montré que le facteur de transcription myéloïde CEBPA, expriméuniquement dans les précurseurs thymiques les plus immatures (ETP), est réprimé par un mécanismed’hyperméthylation dans les LAL-T à l’exception des formes les plus immatures. Il est aujourd’huicommunément admis que les LAL-T constituent une pathologie dite « multi-hits » où les oncogènesde type A affectent la différenciation tandis les oncogènes de type B sont impliqués dans la régulationdu cycle cellulaire, l’auto-renouvellement et/ou l’engagement dans la lignée T. La voie de signalisationde NOTCH, cruciale pour le développement lymphoïde T, est constitutivement activée par la survenuede mutations des gènes NOTCH1 et/ou FBXW7 (N/F) dans environ 60% des LAL-T. La valeurpronostique de ces mutations est controversée. Dans notre travail, nous avons montré que lesmutations de N/F sont plus fréquentes dans les LAL-T arrêtées à un stade de maturation cortical etconfèrent un bon pronostic qui semble toutefois dépendre de la chimiothérapie administrée. Grâce àl’étude de cette large cohorte de LAL-T nous avons pu également établir la fréquence de l’anomalieoncogénique CALM-AF10. Cette dernière est très fréquente dans les LAL-T qui se développent àpartir des ETP dites de mauvais pronostic. Nous avons montré que c’est la présence de l’anomalieCALM-AF10 qui confère le pronostic défavorable à ce sous-type de LAL-T. Contrairement à lalittérature nous n’avons pas retrouvé de valeur pronostique liée à la surexpression des gènes ERG etBAALC. L’étude des anomalies génétiques des LAL-T permet de mieux comprendre l’oncogénèse etd’identifier les anomalies avec une valeur pronostique. L’intérêt de ces travaux est d’apporter une aideaux cliniciens pour une stratification thérapeutique adaptée afin de donner les meilleures chances desurvie aux patients.T-cell acute lymphoblastic leukemia (T-ALL) are lymphoid neoplasms characterized by theproliferation of malignant T lymphoblasts arrested at early stages of maturation. Maturation arrest in TALLmirrors normal lymphopoiesis. Thus we have shown that the myeloid transcription factor CEBPA,expressed only in the most immature thymic precursors (ETP), is commonly repressed byhypermethylation in T-ALL with the exception of the most immature subset. It is now widely acceptedthat T-ALL is a “multi-hits” disease where the type A oncogenes affect the differentiation while type Boncogenes are involved in cell cycle regulation, self-renewal and T-cell commitment. The Notchsignaling pathway, crucial for T cell development, is constitutively activated by the occurrence ofmutations in NOTCH1 and /or FBXW7 (N / F) genes in approximately 60% of T-ALL. The prognosticvalue of these mutations is controversial. In our study, we showed that N/F mutations are morefrequently observed in T-ALL arrested at a cortical stage of maturation and confer a good prognosiswhich seems to be influenced by the therapeutic regimen. In this large cohort of T-ALL we could alsodetermine the frequency of the CALM-AF10 oncogenic abnormality. The latter is very common in TALLdeveloped from ETP wich are of very poor prognosis. We have shown that this is the presence ofCALM-AF10 which confers the poor prognosis in this subtype of T-ALL. Contrary to the litterature wedid not find any prognostic value associated with the overexpression of ERG and BAALC genes. Thestudy of genetic abnormalities in T-ALL provides a better understanding of oncogenesis and identifyabnormalities with prognostic value. The interest of this work is to assist clinicians for an efficienttherapeutic stratification to overcome the poor outcome of T-ALL patients

Détection des anomalies génétiques dans les LAL-T (de la biologie à la clinique)

Les leucémies aiguës lymphoblastiques T (LAL-T) sont caractérisées par la prolifération maligneincontrôlée de précurseurs lymphoïdes T bloqués dans la différenciation. Les stades d arrêt dematuration observés dans les LAL-T reproduisent fidèlement les différentes étapes de la maturationthymique humaine. Ainsi nous avons montré que le facteur de transcription myéloïde CEBPA, expriméuniquement dans les précurseurs thymiques les plus immatures (ETP), est réprimé par un mécanismed hyperméthylation dans les LAL-T à l exception des formes les plus immatures. Il est aujourd huicommunément admis que les LAL-T constituent une pathologie dite multi-hits où les oncogènesde type A affectent la différenciation tandis les oncogènes de type B sont impliqués dans la régulationdu cycle cellulaire, l auto-renouvellement et/ou l engagement dans la lignée T. La voie de signalisationde NOTCH, cruciale pour le développement lymphoïde T, est constitutivement activée par la survenuede mutations des gènes NOTCH1 et/ou FBXW7 (N/F) dans environ 60% des LAL-T. La valeurpronostique de ces mutations est controversée. Dans notre travail, nous avons montré que lesmutations de N/F sont plus fréquentes dans les LAL-T arrêtées à un stade de maturation cortical etconfèrent un bon pronostic qui semble toutefois dépendre de la chimiothérapie administrée. Grâce àl étude de cette large cohorte de LAL-T nous avons pu également établir la fréquence de l anomalieoncogénique CALM-AF10. Cette dernière est très fréquente dans les LAL-T qui se développent àpartir des ETP dites de mauvais pronostic. Nous avons montré que c est la présence de l anomalieCALM-AF10 qui confère le pronostic défavorable à ce sous-type de LAL-T. Contrairement à lalittérature nous n avons pas retrouvé de valeur pronostique liée à la surexpression des gènes ERG etBAALC. L étude des anomalies génétiques des LAL-T permet de mieux comprendre l oncogénèse etd identifier les anomalies avec une valeur pronostique. L intérêt de ces travaux est d apporter une aideaux cliniciens pour une stratification thérapeutique adaptée afin de donner les meilleures chances desurvie aux patients.T-cell acute lymphoblastic leukemia (T-ALL) are lymphoid neoplasms characterized by theproliferation of malignant T lymphoblasts arrested at early stages of maturation. Maturation arrest in TALLmirrors normal lymphopoiesis. Thus we have shown that the myeloid transcription factor CEBPA,expressed only in the most immature thymic precursors (ETP), is commonly repressed byhypermethylation in T-ALL with the exception of the most immature subset. It is now widely acceptedthat T-ALL is a multi-hits disease where the type A oncogenes affect the differentiation while type Boncogenes are involved in cell cycle regulation, self-renewal and T-cell commitment. The Notchsignaling pathway, crucial for T cell development, is constitutively activated by the occurrence ofmutations in NOTCH1 and /or FBXW7 (N / F) genes in approximately 60% of T-ALL. The prognosticvalue of these mutations is controversial. In our study, we showed that N/F mutations are morefrequently observed in T-ALL arrested at a cortical stage of maturation and confer a good prognosiswhich seems to be influenced by the therapeutic regimen. In this large cohort of T-ALL we could alsodetermine the frequency of the CALM-AF10 oncogenic abnormality. The latter is very common in TALLdeveloped from ETP wich are of very poor prognosis. We have shown that this is the presence ofCALM-AF10 which confers the poor prognosis in this subtype of T-ALL. Contrary to the litterature wedid not find any prognostic value associated with the overexpression of ERG and BAALC genes. Thestudy of genetic abnormalities in T-ALL provides a better understanding of oncogenesis and identifyabnormalities with prognostic value. The interest of this work is to assist clinicians for an efficienttherapeutic stratification to overcome the poor outcome of T-ALL patients.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

ALL-associated JAK1 mutations confer hypersensitivity to the antiproliferative effect of type I interferon

Activating mutations in JAK1 have been reported in acute lymphoblastic leukemias (ALLs). In this study, we found a type I interferon (IFN) transcriptional signature in JAK1 mutation-positive human ALL samples. This signature was recapitulated in vitro by the expression of JAK1 mutants in BW5147 and BaF3 hematopoietic cell lines. Binding of JAK1 to the IFN receptor was essential because mutations in the FERM domain abrogated this effect. Beside the constitutive activation of the type I IFN signaling cascade, JAK1 mutations also strongly potentiated the response to IFN in vitro. Typically, the proliferation of cell lines expressing JAK1(A634D) was abrogated by type I IFNs. Interestingly, we found that different JAK1 mutations differentially potentiate responses to type I IFNs or to interleukin-9, another cytokine using JAK1 to mediate its effects. This suggests that the type of mutation influences the specificity of the effect on distinct cytokine receptor signaling. Finally, we also showed in an in vivo leukemia model that cells expressing JAK1(A634D) are hypersensitive to the anti-proliferative and antitumorigenic effect of type I IFN, suggesting that type I IFNs should be considered as a potential therapy for ALL with JAK1-activating mutations. (Blood. 2010; 115(16): 3287-3295

ALL-associated JAK1 mutations confer hypersensitivity to the antiproliferative effect of type I interferon

Activating mutations in JAK1 have been reported in acute lymphoblastic leukemias (ALLs). In this study, we found a type I interferon (IFN) transcriptional signature in JAK1 mutation-positive human ALL samples. This signature was recapitulated in vitro by the expression of JAK1 mutants in BW5147 and BaF3 hematopoietic cell lines. Binding of JAK1 to the IFN receptor was essential because mutations in the FERM domain abrogated this effect. Beside the constitutive activation of the type I IFN signaling cascade, JAK1 mutations also strongly potentiated the response to IFN in vitro. Typically, the proliferation of cell lines expressing JAK1(A634D) was abrogated by type I IFNs. Interestingly, we found that different JAK1 mutations differentially potentiate responses to type I IFNs or to interleukin-9, another cytokine using JAK1 to mediate its effects. This suggests that the type of mutation influences the specificity of the effect on distinct cytokine receptor signaling. Finally, we also showed in an in vivo leukemia model that cells expressing JAK1(A634D) are hypersensitive to the anti-proliferative and antitumorigenic effect of type I IFN, suggesting that type I IFNs should be considered as a potential therapy for ALL with JAK1-activating mutations. (Blood. 2010; 115(16): 3287-3295

MLL-SEPT5 fusion transcript in infant acute myeloid leukemia with t(11;22)(q23;q11).

International audienceChromosomal rearrangements involving the MLL gene at band 11q23 are the most common genetic alteration encountered in infant acute myeloid leukemia. Reciprocal translocation represents the most frequent form of MLL rearrangement. Currently, more than 60 partner genes have been identified. We report here a case of de novo acute myeloid leukemia with a t(11;22)(q23;q11) in a 23-month-old child. Fluorescence in situ hybridization study revealed that the 3'MLL segment was translocated onto the derivative chromosome 22 and the breakpoint on chromosome 22 was located in or near the SEPT5 gene at 22q11.21. Long distance inverse-polymerase chain reaction was used to identify precisely the MLL partner gene and confirmed the MLL-SEPT5 fusion transcript. Involvement of the SEPT5 gene in MLL rearrangement occurs very rarely. Clinical, cytogenetic and molecular features of acute myeloid leukemia with a MLL-SEPT5 fusion gene are reviewed

Technical Validation of a Reverse-Transcription Quantitative Polymerase Chain Reaction In Vitro Diagnostic Test for the Determination of MiR-31-3p Expression Levels in Formalin-Fixed Paraffin-Embedded Metastatic Colorectal Cancer Tumor Specimens

MiR-31-3p expression has been shown to be a predictive biomarker for response to anti-epithelial growth factor receptor therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC). To aid in the quantification of miR-31-3p expression in formalin-fixed paraffin-embedded (FFPE) primary tumor samples from patients with mCRC, a reverse-transcription quantitative polymerase chain reaction (RT-qPCR) assay was developed and validated. Assay development included the identification of a microRNA reference standard and the determination of an appropriate relative quantification cutoff for differentiating low versus high miR-31-3p expression. Sample specimens for the validation studies included both FFPE slides and shavings. Polymerase chain reaction (PCR) efficiency and linearity, analytical sensitivity and specificity, assay robustness, reproducibility, and accuracy were demonstrated across a number of test conditions and differing quantitative PCR platforms. The data from this study provide evidence as to the feasibility of quantifying the expression of miR-31-3p from FFPE tumor tissue using a standardized RT-qPCR assay

The prognosis of CALM-AF10 positive adult T-cell acute lymphoblastic leukemias depends on the stage of maturation arrest.

International audience: CALM-AF10 (also known as PICALM-MLLT10) is the commonest fusion protein in T-cell acute lymphoblastic leukemia, but its prognostic impact remains unclear. Molecular screening at diagnosis identified CALM-AF10 in 30/431 (7%) T-cell acute lymphoblastic leukemia patients aged 16 years and over and 15/234 (6%) in those aged up to 15 years. CALM-AF10 positive patients were predominantly (72%) surface (s)CD3/T-cell receptor negative in adults, but predominantly (67%) T-cell receptor positive in children. Amongst 22 adult CALM-AF10+ patients treated according to the LALA94/GRAALL03-05 protocols, the poor prognosis for event-free survival (p=0.0017) and overall survival (p=0.0014) was restricted to the 15 T-cell receptor negative cases. Amongst CALM-AF10+ T-cell receptor negative patients, 82% demonstrated an early T-cell precursor phenotype, reported to be of poor prognosis in pediatric T-cell acute lymphoblastic leukemia. Early T-cell precursor acute lymphoblastic leukemia corresponded to 22% of adult LALA94/GRAALL03-05 T-cell acute lymphoblastic leukemias, but had no prognostic impact per se. CALM-AF10 fusion within early T-cell precursor acute lymphoblastic leukemia (21%) did, however, identify a poor prognostic group for event-free survival (p=0.04). CALM-AF10 therefore identifies a poor prognostic group within sCD3/T-cell receptor negative adult T-cell acute lymphoblastic leukemias and is over-represented within early T-cell precursor acute lymphoblastic leukemias, where it identifies those likely to fail treatment. Its prognosis and overlap with early T-cell precursor acute lymphoblastic leukemia in pediatric T-cell acute lymphoblastic leukemia merits analysis. The clinical trial GRAALL was registered at Clinical Trials.gov number NCT00327678