001     299835
005     20250318112252.0
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|a 10.1182/bloodadvances.2024014209
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|a 2473-9529
024 7 _ |2 ISSN
|a 2473-9537
037 _ _ |a DKFZ-2025-00572
041 _ _ |a English
082 _ _ |a 610
100 1 _ |a Kempter, Tamara
|b 0
245 _ _ |a Subclonal TP53 and KRAS variants combined with poor treatment response identify ultrahigh-risk pediatric patients with T-ALL.
260 _ _ |a Washington, DC
|b American Society of Hematology
|c 2025
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520 _ _ |a Variations in the TP53 and KRAS genes indicate a particularly adverse prognosis in relapsed pediatric T-cell acute lymphoblastic leukemia (T-ALL). We hypothesized that these variations might be subclonally present at disease onset and contribute to relapse risk. To test this, we examined 2 cohorts of children diagnosed with T-ALL: cohort 1 with 81 patients who relapsed and 79 who matched nonrelapsing controls, and cohort 2 with 226 consecutive patients, 30 of whom relapsed. In cohort 1, targeted sequencing revealed TP53 clonal and subclonal variants in 6 of 81 relapsing patients but none in the nonrelapsing group (P = .014). KRAS alterations were found in 9 of 81 relapsing patients compared with 2 of 79 nonrelapsing patients (P = .032). Survival analysis showed that none of the relapsed patients with TP53 and/or KRAS alterations survived, whereas 19 of 67 relapsed patients without such variants did, with a minimum follow-up time of 3 years (P = .023). In cohort 2, none of the relapsing patients but 10 of 196 nonrelapsing patients carried TP53 or KRAS variants, indicating that mutation status alone does not predict poor prognosis. All 10 nonrelapsing patients with mutations had a favorable early treatment response. Among the total cohort of 386 patients, 188 showed poor treatment response, of whom 69 relapsed. Of these poor responders, 9 harbored TP53 or KRAS variants. In conclusion, subclonal TP53 and KRAS alterations identified at the time of initial diagnosis, along with a poor treatment response, characterize a subset of children with T-ALL who face a dismal prognosis and who may benefit from alternative treatment approaches.
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650 _ 7 |2 NLM Chemicals
|a Tumor Suppressor Protein p53
650 _ 7 |0 EC 3.6.5.2
|2 NLM Chemicals
|a Proto-Oncogene Proteins p21(ras)
650 _ 7 |2 NLM Chemicals
|a KRAS protein, human
650 _ 7 |2 NLM Chemicals
|a TP53 protein, human
650 _ 2 |2 MeSH
|a Humans
650 _ 2 |2 MeSH
|a Tumor Suppressor Protein p53: genetics
650 _ 2 |2 MeSH
|a Proto-Oncogene Proteins p21(ras): genetics
650 _ 2 |2 MeSH
|a Child
650 _ 2 |2 MeSH
|a Precursor T-Cell Lymphoblastic Leukemia-Lymphoma: genetics
650 _ 2 |2 MeSH
|a Precursor T-Cell Lymphoblastic Leukemia-Lymphoma: mortality
650 _ 2 |2 MeSH
|a Precursor T-Cell Lymphoblastic Leukemia-Lymphoma: diagnosis
650 _ 2 |2 MeSH
|a Precursor T-Cell Lymphoblastic Leukemia-Lymphoma: therapy
650 _ 2 |2 MeSH
|a Male
650 _ 2 |2 MeSH
|a Female
650 _ 2 |2 MeSH
|a Child, Preschool
650 _ 2 |2 MeSH
|a Prognosis
650 _ 2 |2 MeSH
|a Adolescent
650 _ 2 |2 MeSH
|a Infant
650 _ 2 |2 MeSH
|a Mutation
650 _ 2 |2 MeSH
|a Treatment Outcome
700 1 _ |a Richter-Pechańska, Paulina
|b 1
700 1 _ |a Michel, Katarzyna
|b 2
700 1 _ |a Rausch, Tobias
|b 3
700 1 _ |a Erarslan-Uysal, Büşra
|b 4
700 1 _ |a Eckert, Cornelia
|b 5
700 1 _ |a Zimmermann, Martin
|b 6
700 1 _ |a Stanulla, Martin
|b 7
700 1 _ |a Schrappe, Martin
|b 8
700 1 _ |a Cario, Gunnar
|b 9
700 1 _ |a Köhrer, Stefan
|b 10
700 1 _ |0 0000-0002-9285-6898
|a Attarbaschi, Andishe
|b 11
700 1 _ |a Korbel, Jan O
|b 12
700 1 _ |a Kunz, Joachim B
|b 13
700 1 _ |0 P:(DE-He78)ca062b8db1ee864e03f0a92897728df3
|a Kulozik, Andreas
|b 14
|e Last author
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|g Vol. 9, no. 6, p. 1267 - 1279
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