Background
To explore the role of genetic factors in the pathogenesis of myelodysplastic syndrome (MDS) in children with different outcomes and to discover the correlation between genetic features and clinical outcomes as well as disease characteristics.
Methods
We analyzed the archived genetic data from 26 patients who were diagnosed of pediatric MDS at our institution between 2015 and 2021, and evaluated the association between different genetic characteristics and clinical manifestations as well as prognosis. We also took 3 patients with different genetic background and outcomes as examples to elaborate the role of genetic factors in different prognoses.
Results
Genetic variations were found in 13 (8 RCC, 4 MDS-EB, 1 MDS-EB-t, the latter two types are classified as advanced MDS) of the 26 patients. In RCC group, transfusion dependency (2/4 vs. 1/4) and disease progression (2/4 vs. 1/4) occurred more frequently in patients with co-occurrence of somatic and germline mutations (CSGMs) than those with somatic mutations alone. CSGMs (4/5 in advanced MDS, 4/8 in RCC), germline pathogenic variants (2/4 in advanced MDS, 1/4 in RCC) and somatic mutations specifically associated with MDS (6/6 in advanced MDS, 8/15 in RCC) were also identified in our study. Three patients with distinct genetic variations taken as examples in our study presented evidently different clinical outcomes. Case 1 with germline and somatic mutations of unknown significance had a relatively slow disease course and a good prognosis. Case 2 with compound heterozygous germline SBDS variants and somatic mutations such as del20q had a reversed disease outcome and a stable clinical course. Case 3 with a germline GATA2 variant and somatic mutations including − 7 had a rapidly progressive course of disease and a worst prognosis.
Conclusion
Our findings indicate that genetic background of pediatric MDS is closely linked with disease characteristic as well as outcome and that CSGMs leads to disease progression and poor clinical manifestations. It should be emphasized that the interaction between certain germline variants and somatic mutations, such as SBDS and del20q, may result in hematopoietic stem cell adaptation (improve hematopoiesis) and reverse adverse clinical outcomes, which can facilitate the development of targeted therapy.