title: Protracted dormancy of pre-leukemic stem cells.
abstract: Cancer stem cells can escape therapeutic killing by adopting a quiescent or dormant state. The reversibility of this condition provides the potential for later recurrence or relapse, potentially many years later. We describe the genomics of a rare case of childhood BCR-ABL1-positive, B-cell precursor acute lymphoblastic leukemia that relapsed, with an acute myeloblastic leukemia immunophenotype, 22 years after the initial diagnosis, sustained remission and presumed cure. The primary and relapsed leukemias shared the identical BCR-ABL1 fusion genomic sequence and two identical immunoglobulin gene rearrangements, indicating that the relapse was a derivative of the founding clone. All other mutational changes (single-nucleotide variant and copy number alterations) were distinct in diagnostic or relapse samples. These data provide unambiguous evidence that leukemia-propagating cells, most probably pre-leukemic stem cells, can remain covert and silent but potentially reactivatable for more than two decades.
authors.affiliation: Centre for Evolution and Cancer, The Institute of Cancer Research, London, Sutton, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Ford
authors.affiliation: Centre for Evolution and Cancer, The Institute of Cancer Research, London, Sutton, UK.|Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: M B
authors.initials: MB
authors.lastname: Mansur
authors.affiliation: Centre for Evolution and Cancer, The Institute of Cancer Research, London, Sutton, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Furness
authors.affiliation: Newcastle Cancer Centre, NICR, Newcastle, UK.
authors.forename: F W
authors.initials: FW
authors.lastname: van Delft
authors.affiliation: Department of Pediatrics, National Kyushu Cancer Centre, Minami-ku, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Okamura
authors.affiliation: Department of Hematology, Saitama Cancer Centre, Ina, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Hematology, Saitama Cancer Centre, Ina, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology, Saitama Cancer Centre, Ina, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kaneko
authors.affiliation: Centre for Evolution and Cancer, The Institute of Cancer Research, London, Sutton, UK.
authors.forename: M
authors.initials: M
authors.lastname: Greaves
mesh_terms: D002675:Child, Preschool; D059472:Exome; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D018628:Gene Dosage; D015321:Gene Rearrangement; D005803:Genes, Immunoglobulin; D006801:Humans; D051740:Ikaros Transcription Factor / Q000235:genetics; D008297:Male; D014411:Neoplastic Stem Cells / Q000473:pathology*; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000473:pathology*
chemical_list: C581634:BCR-ABL1 fusion protein, human; C497239:IKZF1 protein, human; D051740:Ikaros Transcription Factor; D016044:Fusion Proteins, bcr-abl