Genetic Characterization of Pediatric T-cell Acute Lymphoblastic Leukemia

The aim of my thesis has been to characterize genetically pediatric T-cell acute lymphoblastic leukemia (T-ALL). Articles I and II focus on molecular characterization of translocations involving T-cell receptor (TCR) loci. These types of aberration are characteristic for T-ALL and have previously proved pivotal in the identification of genes implicated in leukemogenesis. The translocation t(12;14)(p13;q11) was shown to result in overexpression of CCND2. The t(12;14) is the first neoplasia-associated translocation shown to result in overexpression of CCND2 and the first example of a targeted deregulation of a member of the cyclin-encoding gene family in T-ALL. Cyclin D proteins are crucial to the cell cycle machinery and hence potential oncogenes. The second translocation cloned, t(X;7)(q22;q34), had not previously been reported in a neoplastic disorder. Breakpoint analysis revealed IRS4 as a novel translocation partner to a TCR locus, resulting in deregulated IRS4 expression, both at the gene and protein level. IRS4 plays an important part in several intracellular signalling cascades, including PI3K-AKT, known to be activated in T-ALL. In a subsequent work, I showed that IRS4 can also be targeted by alternative mechanisms in T-ALL, apart from TCR translocations, namely by mutations (Article IV). In Article III, clinical characteristics and cytogenetic aberrations were ascertained and reviewed in a large, population-based Nordic series of 285 pediatric T-ALLs. Survival analyses revealed a correlation between rare TCR translocations and inferior outcome, an association that awaits confirmation in a separate study. Finally, I used several different techniques – fluorescence in situ hybridization, single nucleotide polymorphism (SNP) array, and deep sequencing of 75 selected candidate genes – to characterize co-operative genetic aberrations in a consecutive series of paediatric T-ALL (Article V). One common change identified by SNP array was segemtal uniparental isodisomy (sUPID). This aberration was seen in 44% of the investigated cases, with most being sUPID9p that always were associated with homozygous CDKN2A deletions, with a heterozygous deletion occurring prior to the sUPID9p in all instances. Among the 75 genes investigated by deep sequencing, 14 were mutated in 28 cases. The genes targeted are involved in signalling transduction, epigenetic regulation, and transcription. In some cases, NOTCH1 mutations were seen in minor subclones and lost at relapse, showing that such mutations also can be secondary events. These findings support a multistep leukemogenic process in pediatric T-ALL. In summary, through different approaches and by various methods, the articles included in this thesis have deciphered genetic aberrations in pediatric T-ALL, contributing to a better understanding of leukemogenesis