words) 20Precursor B-cell acute lymphoblastic leukemia (B-ALL) is associated with recurrent mutations that occur 21 in cancer-initiating cells. There is a need to understand how spontaneous driver mutations influence clonal 22 evolution in leukemia. The ETS-transcription factors PU.1 and Spi-B (encoded by Spi1 and Spib) execute 23 a critical role in B cell development and serve as complementary tumour suppressors by opposing the 24 proliferative events mediated by IL-7R signaling. Here, we used a mouse model to conditionally delete 25 Spi1 and Spib genes in developing B cells. These mice developed B-ALL with a median time to euthanasia 26 of 18 weeks. We performed RNA and whole-exome sequencing (WES) on leukemias isolated from Mb1-27CreΔPB mice and identified single-nucleotide variants (SNVs) in Jak1, Jak3 and Ikzf3 genes, resulting in 28 amino acid changes and in the gain of early stop-codons. JAK3 mutations resulted in amino acid 29 substitutions located in the pseudo-kinase (R653H, V670A) and in the kinase (T844M) domains. 30
Introduction of these mutations into wild-type pro-B cells conferred survival and proliferation advantages. 31We conclude that mutations in Janus kinases represent secondary drivers of leukemogenesis in the absence 32 of Spi-B and PU.1 transcription factors. This mouse model represents an useful tool to study clonal 33 evolution and tumour heterogeneity in B-ALL. 34
Introduction 35Acute lymphoblastic leukemia is the most common type of childhood cancer, with approximately 36 6000 new cases diagnosed in the United States each year 1 . Most leukemias originate within the B cell 37 rather than the T cell lineage 2,3 . Precursor B cell acute lymphoblastic leukemia (pre-B-ALL) is a disease 38 that is revealed by the presence of transformed precursor B cells in the blood, bone marrow, and tissues; 39 and is most common in 1-5 year old patients 4 . Most pre-B-ALL cases are associated with genetic 40 abnormalities that include chromosomal translocations or point mutations. In pre-B-ALL, up to two thirds 41 of genes with point mutations encode transcriptional regulators such as Pax-5, Ikaros, or EBF1 3 . Pre-B-42 ALL cells are frequently arrested at an early stage of development, express interleukin-7 receptor (IL7R), 43and have high levels of Janus Kinase (JAK)-STAT signaling to sustain survival and proliferation [5][6][7] . 44Activating mutations of the IL7R gene have been described in human pre-B-ALL 8 . JAK and IL7R 45 mutations are frequent in several subtypes of pre-B-ALL including the recently described disease Ph-like 46 leukemia 9,10 . In summary, mutations that activate cytokine signaling, and impair differentiation, function 47 as driver mutations in pre-B-ALL. 48 PU.1 (encoded by SPI1) and Spi-B (encoded SPIB in mice) are transcription factors of the E26-49 transformation-specific (ETS) family 11 . These two proteins share a conserved DNA binding domain and 50 interact with an overlapping set of DNA binding sites within the genome 12 . PU.1 and Spi-B complement 51 one anothers function...