Abstract 2176

Poster Board II-153

Progression from chronic phase to blast crisis (BC) remains a major hurdle on the road to effective treatment of chronic myeloid leukemia (CML). BC is known to be associated with accumulation of additional genetic alterations, but these alterations have so far been only partially characterized. The development of SNP-arrays as a tool for high-resolution karyotyping now allows to perform high-throughput genome-wide screens for submicroscopic genomic alterations with unprecedented informativity and resolution and to precisely map all the genes involved in these alterations. We have used Human 6.0 SNP Arrays (Affymetrix) to perform high-resolution molecular allelokaryotyping of 25 DNA samples from BC (myeloid, n=16; lymphoid, n=9) CML patients (pts). The 6.0 SNP Array technology relies on 1.8 million markers evenly spaced across the genome, with a median inter-marker distance <700 bp. Loss of Heterozygosity (LOH) analysis identified several recurrent regions of uniparental disomy (UPD) ranging from 970Kb to 2.4Mb: 3p21.31-3p21.2 (19 pts); 4p15.1 (n=18 pts); 14q23.3 (n=18 pts); 8q22.2 (n=15 pts); 7q31.31 (n=14 pts); 3q11.2 (13 pts); 17q23.2 (n=13 pts); 12q24.11-12q24.13 (n=12 pts); 15q15.2-15q15.3 (n=12 pts); 16q22.1 (n=12 pts); 10q22.1-10q22.2 (n=11 pts); 1p34.3 (n=10pts); 7q11.22 (n=10 pts); 8p11.12 (n=10 pts); 15q23-15q24.1 (n=9 pts); 20q11.22-20q11.23 (n=7 pts); 16q11.2 (n=6 pts); 17q11.2 (n=5 pts). Three pts had evidence of UPD involving the whole long arm of chromosomes 5, 14 and 19, respectively. Macroscopic copy number alterations (CNAs) (+8, +19, +14q; +21q; -7; -18, -16q; -17p; -6p; -6q; -9q) were frequent and easily detected. A variety of submicroscopic CNAs were also detected. However, we decided to exploit the unprecedented resolution power of Human 6.0 SNP Arrays and the ability of Genotyping Console 3.0.2 (Affymetrix) software to precisely pinpoint the borders of these CNAs. We thus aimed our analysis to the identification of very small CNAs that may have been missed by previous studies - all using less sensitive assays. This approach revealed a high number of focal gains or losses ranging from 4 to 47Kb, affecting single genes or even some exons only. Genes involved in >2 pts are listed in the Table below. Gains/losses mapping to known regions of copy number variation (CNV) were excluded.

Gene SymbolType of CNAExons involvedChromosomal locationNo of pts harboring CNAs
MDM4 All 7q22.11 5 pts 
HGF All 1q32.1 4 pts 
NRAS* All 1p13.2 3 pts 
HRAS* All 11p15.5 3 pts 
KRAS* All 12p12.1 5 pts 
AKT3* md One or more 1q43 13 pts 
CDC73 md One or more 1q31.2 8 pts 
RB1 md+a One or more 13q14.2 8 pts 
ERG md/bd One or more 21q22.3 8 pts 
ETS1 One or more 11q24.3 8 pts 
ETV1 One or more 7p21.2 7 pts 
SMAD2 ma+d One or more 18q21.1 7 pts 
PIK3CA* ma+d One or more 3p26.32 6 pts 
SKAP2 One or more 7p15.2 5 pts 
EPHA3 One or more 3p11.2 5 pts 
KALRN* md One or more 3q21.2 5 pts 
FHIT md One or more 3p14.2 5 pts 
JAK1 One or more 1p32.3 5 pts 
JAK2 ma+d One or more 9p24.1 4 pts 
AKT2* md One or more 19p13.2 4 pts 
SOS1* md One or more 2p22.1 4 pts 
PTEN* ma+d One or more 10q23.31 4 pts 
FGFR2 One or more 10q26.3 4 pts 
ETV5 One or more 3q27.2 4 pts 
MET One or more 7q31.2 4 pts 
PBX4 md One or more 19p13.11 4 pts 
NRG1 md One or more 8p12 4 pts 
FAF1 md One or more 1p33 4 pts 
GAS2 md One or more 11p14.3 3 pts 
TEC One or more 4p12 3 pts 
PTCH1 ma+d One or more 9q22.32 3 pts 
PIK3R1* One or more 5q13.1 3 pts 
GRB2* One or more 17q24 3 pts 
PAK2* md One or more 3q29 3 pts 
RUNX1T1 One or more 8q21.3 3 pts 
Gene SymbolType of CNAExons involvedChromosomal locationNo of pts harboring CNAs
MDM4 All 7q22.11 5 pts 
HGF All 1q32.1 4 pts 
NRAS* All 1p13.2 3 pts 
HRAS* All 11p15.5 3 pts 
KRAS* All 12p12.1 5 pts 
AKT3* md One or more 1q43 13 pts 
CDC73 md One or more 1q31.2 8 pts 
RB1 md+a One or more 13q14.2 8 pts 
ERG md/bd One or more 21q22.3 8 pts 
ETS1 One or more 11q24.3 8 pts 
ETV1 One or more 7p21.2 7 pts 
SMAD2 ma+d One or more 18q21.1 7 pts 
PIK3CA* ma+d One or more 3p26.32 6 pts 
SKAP2 One or more 7p15.2 5 pts 
EPHA3 One or more 3p11.2 5 pts 
KALRN* md One or more 3q21.2 5 pts 
FHIT md One or more 3p14.2 5 pts 
JAK1 One or more 1p32.3 5 pts 
JAK2 ma+d One or more 9p24.1 4 pts 
AKT2* md One or more 19p13.2 4 pts 
SOS1* md One or more 2p22.1 4 pts 
PTEN* ma+d One or more 10q23.31 4 pts 
FGFR2 One or more 10q26.3 4 pts 
ETV5 One or more 3q27.2 4 pts 
MET One or more 7q31.2 4 pts 
PBX4 md One or more 19p13.11 4 pts 
NRG1 md One or more 8p12 4 pts 
FAF1 md One or more 1p33 4 pts 
GAS2 md One or more 11p14.3 3 pts 
TEC One or more 4p12 3 pts 
PTCH1 ma+d One or more 9q22.32 3 pts 
PIK3R1* One or more 5q13.1 3 pts 
GRB2* One or more 17q24 3 pts 
PAK2* md One or more 3q29 3 pts 
RUNX1T1 One or more 8q21.3 3 pts 

Abbreviations: md, monoallelic deletion; bd, biallelic deletion; a, amplification; ma+d, complex pattern of monoallelic deletion of some exons and amplification of other exons

All the genes found to harbor CNAs were transcription factors, adaptor proteins, receptor and non-receptor kinases involved in cell proliferation and apoptosis - with a known role as oncogenes or tumor suppressors or oncogene/tumor suppressor interactors. Although these results confirm a high degrees of heterogeneity in the alterations detectable in BC CML pts, members of the RAS pathway (indicated with an asterisk) were the most frequently altered genes. Further characterization by polymerase chain reaction and sequencing is ongoing. In conclusion, the power of 6.0 SNP Array technology allowed us to detect previously unidentified alterations targeting whole or part of key oncogenes or tumor suppressors whose deregulation may play a role in determining the aggressive phenotype of BC CML, and which may represent potential therapeutic targets. Supported by European LeukemiaNet, AIL, AIRC, PRIN, Fondazione del Monte di Bologna e Ravenna.

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.

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