Distinct clinical and biological features of de novo acute myeloid leukemia with additional sex comb-like 1 (ASXL1) mutations.
Mutations in the additional sex comb-like 1 (ASXL1) gene were recently shown in various myeloid malignancies, but they have not been comprehensively investigated in acute myeloid leukemia (AML). In this study, we analyzed ASXL1 mutations in exon 12 in 501 adults with de novo AML. ASXL1 mutations were detected in 54 patients (10.8%), 8.9% among those with normal karyotype and 12.9% among those with abnormal cytogenetics. The mutation was closely associated with older age, male sex, isolated trisomy 8, RUNX1 mutation, and expression of human leukocyte antigen-DR and CD34, but inversely associated with t(15;17), complex cytogenetics, FLT3-internal tandem duplication, NPM1 mutations, WT1 mutations, and expression of CD33 and CD15. Patients with ASXL1 mutations had a shorter overall survival than patients without, but the mutation was not an independent adverse prognostic factor in multivariate analysis. Sequential analyses showed that the original ASXL1 mutations were lost at relapse and/or refractory status in 2 of the 6 relapsed ASXL1-mutated patients studied, whereas 2 of the 109 ASXL1-wild patients acquired a novel ASXL1 mutation at relapse. In conclusion, AML bearing ASXL1 mutations showed distinct clinical and biological features. The ASXL1 mutation status can change during disease evolution in a few patients.
Chou
Wen-Chien
WC
Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. wchou@ntu.edu.tw
Huang
Huai-Hsuan
HH
Hou
Hsin-An
HA
Chen
Chien-Yuan
CY
Tang
Jih-Luh
JL
Yao
Ming
M
Tsay
Woei
W
Ko
Bor-Sheng
BS
Wu
Shang-Ju
SJ
Huang
Shang-Yi
SY
Hsu
Szu-Chun
SC
Chen
Yao-Chang
YC
Huang
Yen-Ning
YN
Chang
Yi-Chang
YC
Lee
Fen-Yu
FY
Liu
Min-Chih
MC
Liu
Chia-Wen
CW
Tseng
Mei-Hsuan
MH
Huang
Chi-Fei
CF
Tien
Hwei-Fang
HF
D000328:Adult; D004252:DNA Mutational Analysis; D005091:Exons / Q000235:genetics; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology* / Q000628:therapy; D015999:Multivariate Analysis; D009154:Mutation / Q000235:genetics*; D000090243:Nucleophosmin; D012097:Repressor Proteins / Q000235:genetics*; D016019:Survival Analysis; D016896:Treatment Outcome
C473949:ASXL1 protein, human; C000716967:NPM1 protein, human; D012097:Repressor Proteins; D000090243:Nucleophosmin