Non-driver mutations landscape in different stages of primary myelofibrosis determined ASXL1 mutations play a critical role in disease progression

Abstract

Abstract Except for driver mutations (JAK2, MPL, CALR), primary myelofibrosis (PMF) patients have much more non-driver mutations than polycythemia vera (PV) and essential thrombocythemia (ET) patients. The relationship between disease progression (prefibrotic (Pre) to overtfibrotic (Overt) to accelerate phase/blast phase (AP/BP)) and non-driver mutations is still not very clear. To uncover the effect of these non-driver mutations in the progression of PMF, we retrospectively analyzed 275 samples in different stages (69 Pre-PMF, 161 Overt-PMF and 45 PMF-AP/BP) from 258 consecutive patients. Univariate analysis showed that ASXL1 mutations were closely related to PMF progression with increasing frequency in this process. Multivariate analysis furtherly confirmed that ASXL1 mutations were enriched both in Overt-PMF and in PMF-AP/BP, while U2AF1 mutations were only enriched in Overt-PMF and RUNX1 and NRAS mutations were only enriched in PMF-AP/BP. The data of serial samples from Overt-PMF patients who developed to AP/BP showed that ASXL1 mutations more frequently co-occurred with newly acquired RAS pathway mutations, while RUNX1 mutations were usually freshly acquired with independence on ASXL1 mutations during AP/BP transformation. Collectively, ASXL1 mutations may play a crucial role in the whole course of PMF progression and should be targeted as potential intervention point.