Genomic heterogeneity contributed to different prognosis between adult and pediatric acute lymphoblastic

Abstract

The prognosis of acute lymphoblastic leukemia (ALL) in adults is inferior to that in children. Hence, ALL remains challenging to cure in the adult population. Aberrant genetic alterations have been observed in ALL, although the patterns of differential gene alterations in adult and pediatric ALL have not been comprehensively determined on a genome‐wide scale. We investigated the biologic differences in genomic profiles between adults (n = 64) and children (n = 54) with ALL and relationship between genomic heterogeneity and prognosis. The 2 populations showed similar common mutation types but an increased prevalence of genetic alterations in adult ALL. The median numbers of gene mutations were 17 (range: 1–53) and 4.5 (range: 1–19) per sample in adult and pediatric ALL, respectively (p < 0.001). An increased number of gene mutations and age were significantly correlated (R2 = 0.5853, p < 0.001). We identified 122 and 53 driver genes in adult and pediatric ALL samples, respectively. IKZF1, IDH1, and TTN mutations were significantly enriched in adult patients with ALL. KRAS, ARID1A, and CREBBP mutations were significantly enriched in pediatric patients with ALL (p < 0.05). The incidence of relapse was 40.0% and 9.6% in adult and pediatric patients with ALL, respectively (p = 0.003). The overall survival and relapse‐free survival of adult patients with ALL were poorer than those of pediatric patients with ALL (p = 0.002 and p < 0.001, respectively). This genomic landscape enhances the understanding of the biologic differences in ALL between the 2 populations and provides insight for developing therapeutic approaches.

PAX5 fusion genes in acute lymphoblastic leukemia: A literature review

“…[44] Furthermore, adult ALL cases have a poor prognosis, [45] with a relapse rate of 40.0% compared to 9.6% in pediatrics. [46] Treating ALL remains challenging due to the high risk of relapse shortly after complete remission, [46] which often results in refractory leukemia that is difficult to cure, with a 5-year overall survival rate of approximately 50%. [45] This review will focus on the implications of PAX5 mutations in ALL development, particularly B-ALL.…”