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Blood, 30 July 2009, Vol. 114, No. 5, pp. 1038-1045. Prepublished online as a Blood First Edition Paper on June 3, 2009; DOI 10.1182/blood-2008-12-192039.
LYMPHOID NEOPLASIA WT1 mutations in T-ALL1 Institute for Cancer Genetics, Columbia University, New York, NY; 2 Cancer Institute, Department of Haematology, University College London, London, United Kingdom; 3 Hemato-Oncology Laboratory, Department of Pediatrics, University of Padua, Padua, Italy; Departments of 4 Pediatrics and 5 Pathology, Columbia University Medical Center, New York, NY; 6 Andalusian Stem Cell Bank, Centro de Investigacion Biomedica, Granada, Spain; 7 Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA; 8 Clinical Trial Service Unit, Oxford, United Kingdom; 9 University College London Hospitals, London, United Kingdom; 10 Rambam Medical Center and Technion, Israel Institute of Technology, Haifa, Israel; 11 Montefiore Medical Center North, Bronx, NY; 12 New York Medical College, New York, NY; 13 Department of Pediatric Oncology/Hematology, Erasmus MC–Sophia Children's Hospital, Rotterdam, The Netherlands; 14 Dutch Childhood Oncology Group, The Hague, The Netherlands; 15 Clinic for Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and 16 German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia, Hamburg, Germany The molecular mechanisms involved in disease progression and relapse in T-cell acute lymphoblastic leukemia (T-ALL) are poorly understood. We used single nucleotide polymorphism array analysis to analyze paired diagnostic and relapsed T-ALL samples to identify recurrent genetic alterations in T-ALL. This analysis showed that diagnosis and relapsed cases have common genetic alterations, but also that relapsed samples frequently lose chromosomal markers present at diagnosis, suggesting that relapsed T-ALL emerges from an ancestral clone different from the major leukemic population at diagnosis. In addition, we identified deletions and associated mutations in the WT1 tumor suppressor gene in 2 of 9 samples. Subsequent analysis showed WT1 mutations in 28 of 211 (13.2%) of pediatric and 10 of 85 (11.7%) of adult T-ALL cases. WT1 mutations present in T-ALL are predominantly heterozygous frameshift mutations resulting in truncation of the C-terminal zinc finger domains of this transcription factor. WT1 mutations are most prominently found in T-ALL cases with aberrant rearrangements of the oncogenic TLX1, TLX3, and HOXA transcription factor oncogenes. Survival analysis demonstrated that WT1 mutations do not confer adverse prognosis in pediatric and adult T-ALL. Overall, these results identify the presence of WT1 mutations as a recurrent genetic alteration in T-ALL.
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