Author:
Burlet Bénédicte,Ramla Selim,Fournier Cyril,Abrey-Recalde Maria Jimena,Sauter Camille,Chrétien Marie-Lorraine,Rossi Cédric,Duffourd Yannis,Ragot Sylviane,Buriller Céline,Tournier Benjamin,Chapusot Caroline,Nadal Nathalie,Racine Jessica,Guy Julien,Bailly François,Martin Laurent,Casasnovas Olivier,Bastie Jean-Noël,Caillot Denis,Albuisson Juliette,Broccardo Cyril,Thieblemont Catherine,Delva Laurent,Maynadié Marc,Aucagne Romain,Callanan Mary B.
Abstract
Diagnosis of B-cell chronic lymphocytic leukemia (B-CLL) is usually straightforward, involving clinical, immunophenotypic (Matutes score), and (immuno)genetic analyses (to refine patient prognosis for treatment). CLL cases with atypical presentation (e.g., Matutes ≤ 3) are also encountered, and for these diseases, biology and prognostic impact are less clear. Here we report the genomic characterization of a case of atypical B-CLL in a 70-yr-old male patient; B-CLL cells showed a Matutes score of 3, chromosomal translocation t(14;18)(q32;q21) (BCL2/IGH), mutated IGHV, deletion 17p, and mutations in BCL2, NOTCH1 (subclonal), and TP53 (subclonal). Quite strikingly, a novel PAX5 mutation that was predicted to be loss of function was also seen. Exome sequencing identified, in addition, a potentially actionable BRAF mutation, together with novel somatic mutations affecting the homeobox transcription factor NKX2-3, known to control B-lymphocyte development and homing, and the epigenetic regulator LRIF1, which is implicated in chromatin compaction and gene silencing. Neither NKX2-3 nor LRIF1 mutations, predicted to be loss of function, have previously been reported in B-CLL. Sequencing confirmed the presence of these mutations together with BCL2, NOTCH1, and BRAF mutations, with the t(14;18)(q32;q21) translocation, in the initial diagnostic sample obtained 12 yr prior. This is suggestive of a role for these novel mutations in B-CLL initiation and stable clonal evolution, including upon treatment withdrawal. This case extends the spectrum of atypical B-CLL with t(14;18)(q32;q21) and highlights the value of more global precision genomics for patient follow-up and treatment in these patients.
Publisher
Cold Spring Harbor Laboratory
Cited by
1 articles.
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