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TP53 Germline Variations Influence the Predisposition and Prognosis of B-Cell Acute Lymphoblastic Leukemia in Children.

Publication ,  Journal Article
Qian, M; Cao, X; Devidas, M; Yang, W; Cheng, C; Dai, Y; Carroll, A; Heerema, NA; Zhang, H; Moriyama, T; Gastier-Foster, JM; Xu, H; Raetz, E ...
Published in: J Clin Oncol
February 20, 2018

Purpose Germline TP53 variation is the genetic basis of Li-Fraumeni syndrome, a highly penetrant cancer predisposition condition. Recent reports of germline TP53 variants in childhood hypodiploid acute lymphoblastic leukemia (ALL) suggest that this type of leukemia is another manifestation of Li-Fraumeni syndrome; however, the pattern, prevalence, and clinical relevance of TP53 variants in childhood ALL remain unknown. Patients and Methods Targeted sequencing of TP53 coding regions was performed in 3,801 children from the Children's Oncology Group frontline ALL clinical trials, AALL0232 and P9900. TP53 variant pathogenicity was evaluated according to experimentally determined transcriptional activity, in silico prediction of damaging effects, and prevalence in non-ALL control populations. TP53 variants were analyzed for their association with ALL presenting features and treatment outcomes. Results We identified 49 unique nonsilent rare TP53 coding variants in 77 (2.0%) of 3,801 patients sequenced, of which 22 variants were classified as pathogenic. TP53 pathogenic variants were significantly over-represented in ALL compared with non-ALL controls (odds ratio, 5.2; P < .001). Children with TP53 pathogenic variants were significantly older at ALL diagnosis (median age, 15.5 years v 7.3 years; P < .001) and were more likely to have hypodiploid ALL (65.4% v 1.2%; P < .001). Carrying germline TP53 pathogenic variants was associated with inferior event-free survival and overall survival (hazard ratio, 4.2 and 3.9; P < .001 and .001, respectively). In particular, children with TP53 pathogenic variants were at a dramatically higher risk of second cancers than those without pathogenic variants, with 5-year cumulative incidence of 25.1% and 0.7% ( P < .001), respectively. Conclusion Loss-of-function germline TP53 variants predispose children to ALL and to adverse treatment outcomes with ALL therapy, particularly the risk of second malignant neoplasms.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

February 20, 2018

Volume

36

Issue

6

Start / End Page

591 / 599

Location

United States

Related Subject Headings

  • Tumor Suppressor Protein p53
  • Prognosis
  • Precursor B-Cell Lymphoblastic Leukemia-Lymphoma
  • Oncology & Carcinogenesis
  • Male
  • Humans
  • Germ-Line Mutation
  • Genetic Predisposition to Disease
  • Female
  • Child
 

Citation

APA
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ICMJE
MLA
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Qian, M., Cao, X., Devidas, M., Yang, W., Cheng, C., Dai, Y., … Yang, J. J. (2018). TP53 Germline Variations Influence the Predisposition and Prognosis of B-Cell Acute Lymphoblastic Leukemia in Children. J Clin Oncol, 36(6), 591–599. https://doi.org/10.1200/JCO.2017.75.5215
Qian, Maoxiang, Xueyuan Cao, Meenakshi Devidas, Wenjian Yang, Cheng Cheng, Yunfeng Dai, Andrew Carroll, et al. “TP53 Germline Variations Influence the Predisposition and Prognosis of B-Cell Acute Lymphoblastic Leukemia in Children.J Clin Oncol 36, no. 6 (February 20, 2018): 591–99. https://doi.org/10.1200/JCO.2017.75.5215.
Qian M, Cao X, Devidas M, Yang W, Cheng C, Dai Y, et al. TP53 Germline Variations Influence the Predisposition and Prognosis of B-Cell Acute Lymphoblastic Leukemia in Children. J Clin Oncol. 2018 Feb 20;36(6):591–9.
Qian, Maoxiang, et al. “TP53 Germline Variations Influence the Predisposition and Prognosis of B-Cell Acute Lymphoblastic Leukemia in Children.J Clin Oncol, vol. 36, no. 6, Feb. 2018, pp. 591–99. Pubmed, doi:10.1200/JCO.2017.75.5215.
Qian M, Cao X, Devidas M, Yang W, Cheng C, Dai Y, Carroll A, Heerema NA, Zhang H, Moriyama T, Gastier-Foster JM, Xu H, Raetz E, Larsen E, Winick N, Bowman WP, Martin PL, Mardis ER, Fulton R, Zambetti G, Borowitz M, Wood B, Nichols KE, Carroll WL, Pui C-H, Mullighan CG, Evans WE, Hunger SP, Relling MV, Loh ML, Yang JJ. TP53 Germline Variations Influence the Predisposition and Prognosis of B-Cell Acute Lymphoblastic Leukemia in Children. J Clin Oncol. 2018 Feb 20;36(6):591–599.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

February 20, 2018

Volume

36

Issue

6

Start / End Page

591 / 599

Location

United States

Related Subject Headings

  • Tumor Suppressor Protein p53
  • Prognosis
  • Precursor B-Cell Lymphoblastic Leukemia-Lymphoma
  • Oncology & Carcinogenesis
  • Male
  • Humans
  • Germ-Line Mutation
  • Genetic Predisposition to Disease
  • Female
  • Child