Disease evolution and outcomes in familial AML with germline CEBPA mutations

Tawana, Kiran; Wang, Jun; Renneville, Aline; Bödör, Csaba; Hills, Robert; Loveday, Chey; Savic, Aleksandar; Van Delft, Frederik W; Treleaven, Jennifer; Georgiades, Panayiotis; Uglow, Elizabeth; Asou, Norio; Uike, Naokuni; Debeljak, Maruša; Jazbec, Janez; Ancliff, Philip; Gale, Rosemary; Thomas, Xavier; Mialou, Valerie; Döhner, Konstanze; ... (2015). Disease evolution and outcomes in familial AML with germline CEBPA mutations. Blood, 126(10), pp. 1214-1223. American Society of Hematology 10.1182/blood-2015-05-647172

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In-depth molecular investigation of familial leukemia has been limited by the rarity of recognized cases. This study examines the genetic events initiating leukemia and details the clinical progression of disease across multiple families harboring germ-line CEBPA mutations. Clinical data were collected from 10 CEBPA-mutated families, representing 24 members with acute myeloid leukemia (AML). Whole-exome (WES) and deep sequencing were performed to genetically profile tumors and define patterns of clonal evolution. Germline CEBPA mutations clustered within the N-terminal and were highly penetrant, with AML presenting at a median age of 24.5 years (range, 1.75-46 years). In all diagnostic tumors tested (n = 18), double CEBPA mutations (CEBPAdm) were detected, with acquired (somatic) mutations preferentially targeting the C-terminal. Somatic CEBPA mutations were unstable throughout the disease course, with different mutations identified at recurrence. Deep sequencing of diagnostic and relapse paired samples confirmed that relapse-associated CEBPA mutations were absent at diagnosis, suggesting recurrence was triggered by novel, independent clones. Integrated WES and deep sequencing subsequently revealed an entirely new complement of mutations at relapse, verifying the presentation of a de novo leukemic episode. The cumulative incidence of relapse in familial AML was 56% at 10 years (n = 11), and 3 patients experienced ≥3 disease episodes over a period of 17 to 20 years. Durable responses to secondary therapies were observed, with prolonged median survival after relapse (8 years) and long-term overall survival (10-year overall survival, 67%). Our data reveal that familial CEBPA-mutated AML exhibits a unique model of disease progression, associated with favorable long-term outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology

UniBE Contributor:

Pabst, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0006-4971

Publisher:

American Society of Hematology

Language:

English

Submitter:

Marianne Zahn

Date Deposited:

17 Mar 2016 14:43

Last Modified:

18 Mar 2016 10:10

Publisher DOI:

10.1182/blood-2015-05-647172

PubMed ID:

26162409

BORIS DOI:

10.7892/boris.77197

URI:

https://boris.unibe.ch/id/eprint/77197

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