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Blood, 15 November 2007, Vol. 110, No. 10, pp. 3706-3714.
Prepublished online as a Blood First Edition Paper on August 1, 2007; DOI 10.1182/blood-2007-02-073486.
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NEOPLASIA
Distinct gene expression profiles of acute myeloid/T-lymphoid leukemia with silenced CEBPA and mutations in NOTCH1
Bas J. Wouters1,
Meritxell Alberich Jordà2,
Karen Keeshan3,
Irene Louwers1,
Claudia A. J. Erpelinck-Verschueren1,
Dennis Tielemans4,
Anton W. Langerak4,
Yiping He3,
Yumi Yashiro-Ohtani3,
Pu Zhang2,
Christopher J. Hetherington2,
Roel G. W. Verhaak1,
Peter J. M. Valk1,
Bob Löwenberg1,
Daniel G. Tenen2,
Warren S. Pear3, and
Ruud Delwel1
1 Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands;
2 Harvard Institutes of Medicine, Boston, MA;
3 Abramson Family Cancer Research Institute and Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia; and
4 Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
Gene expression profiling of acute myeloid leukemia (AML) allows the discovery of previously unrecognized molecular entities. Here, we identified a specific subgroup of AML, defined by an expression profile resembling that of AMLs with mutations in the myeloid transcription factor CCAAT/enhancer-binding protein alpha (C/EBP ), while lacking such mutations. We found that in these leukemias, the CEBPA gene was silenced, which was associated with frequent promoter hypermethylation. The leukemias phenotypically showed aberrant expression of T-cell genes, of which CD7 was most consistent. We identified 2 mechanisms that may contribute to this phenotype. First, absence of Cebpa led to up-regulation of specific T-cell transcripts (ie, Cd7 and Lck) in hematopoietic stem cells isolated from conditional Cebpa knockout mice. Second, the enhanced expression of TRIB2, which we identify here as a direct target of the T-cell commitment factor NOTCH1, suggested aberrantly activated Notch signaling. Putatively activating NOTCH1 mutations were found in several specimens of the newly identified subgroup, while a large set of control AMLs was mutation negative. A gene expression prediction signature allowed the detection of similar cases of leukemia in independent series of AML.

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