However, the relevance of these findings to childhood AML remains unclear, since several of the most 53 common adult mutations appear far less prevalent in pediatric AML 6,7 . 54To date, no comprehensive characterization of pediatric AML has been described. Here, we report the 55 initial results of the TARGET (Therapeutically Applicable Research to Generate Effective Treatments) 56 AML initiative, a collaborative COG/NCI project to comprehensively characterize the mutational, 57 transcriptional, and epigenetic landscapes of a large, well-annotated cohort of pediatric AML. 58Comparing AML molecular profiles across age groups, we show that stark differences in mutations,d 59 structural variants and DNA methylation distinguish AML in infants, children, adolescents, and adults. 60
Results
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Overview of cohort characteristics 62A total of 1023 children enrolled in COG studies are included in the TARGET AML dataset. 63Comprehensive clinical data, including clinical outcomes and test results for common sequence 64 aberrations (outlined in We carried out analyses of microRNA, mRNA, and/or DNA methylation in 412 subjects. A summary of 94 the assays performed and case-assay overlap is presented in Fig. S3. We compared our verified variants 95 to those of 177 adult AML cases from The Cancer Genome Atlas (TCGA) project 3 , stratified by the age 96 groupings outlined in Fig. 1a. The TARGET and TCGA discovery cohorts both contained numerous AYA 97 patients (Table S3). Importantly, our conclusions regarding the molecular characteristics of this age 98 group are identical when analyzing either or both cohorts (Fig. S4). 99
Somatic gene mutations in pediatric AML 100Like adult AML, pediatric AML has one of the lowest rates of mutation among molecularly well-101 characterized cancers (Fig. S5), with < 1 somatic, protein-coding change per megabase in most cases. 102However, the landscape of somatic variants in pediatric AML is markedly different from that reported in 103 adults 3,4 (Figs. 2b, S6-S7, Table S4). RAS, KIT, and FLT3 alterations, including novel, pediatric-specific 104 FLT3 mutations (FLT3.N), are more common in children. Mutational burden increases with age, yet older 105 patients have relatively fewer recurrent cytogenetic alterations. Indeed, the number of coding SNVs, 106 within and across cohorts, is best predicted by age (Fig. 2c, p<10 -15 ) and by cytogenetic subgroup. In 107 contradistinction to the higher prevalence of small sequence variants in older patients, recurrent 108 structural alterations, fusions, and focal copy number aberrations are more common in younger patients 109 (Figs. 2d-e, p<10 -3 , see below). Patients with CBFA2T3-GLIS2, KMT2A, or NUP98 fusions tend to have 110 . CC-BY 4.0 International license peer-reviewed) is the author/funder. It is made available under a The copyright holder for this preprint (which was not . http://dx.doi.org/10.1101/125609 doi: bioRxiv preprint first posted online Jun. 13, 2017; fewer mutations (p<10 -9 ), with subgroups demonstrating inferior clinical outcome...