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Disease evolution and outcomes in familial AML with germline CEBPA mutations

Lookup NU author(s): Dr Frederik van DelftORCiD

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Abstract

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.


Publication metadata

Author(s): Tawana K, Wang J, Renneville A, Bodor C, Hills R, Loveday C, Savic A, van Delft FW, Treleaven J, Georgiades P, Uglow E, Asou N, Uike N, Debeljak M, Jazbec J, Ancliff P, Gale R, Thomas X, Mialou V, Dohner K, Bullinger L, Mueller B, Pabst T, Stelljes M, Schlegelberger B, Wozniak E, Iqbal S, Okosun J, Araf S, Frank AK, Lauridsen FB, Porse B, Nerlov C, Owen C, Dokal I, Gribben J, Smith M, Preudhomme C, Chelala C, Cavenagh J, Fitzgibbon J

Publication type: Article

Publication status: Published

Journal: Blood

Year: 2015

Volume: 126

Issue: 10

Pages: 1214-1223

Print publication date: 03/09/2015

Online publication date: 10/07/2015

Acceptance date: 01/07/2015

ISSN (print): 0006-4971

ISSN (electronic): 1528-0020

Publisher: American Society of Hematology

URL: http://dx.doi.org/10.1182/blood-2015-05-647172

DOI: 10.1182/blood-2015-05-647172


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Funding

Funder referenceFunder name
German Research Foundation for Cluster of Excellence (REBIRTH) from Regenerative Biology to Reconstructive Therapy
NovoNordisk Foundation
Cancer Research UK (CR-UK) through Clinical Research Fellowship
Children with Cancer
Kay Kendall Intermediate Fellowship
14032Leukaemia Lymphoma Research
26461431Japanese Ministry of Education, Culture, Sport, Science and Technology JSPS KAKENHI
PD-108805Hungarian Scientific Research Fund

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