Abstract

T-ALL relapse usually occurs early but can occur much later, which has been suggested to represent a de novo leukemia. However, we conclusively demonstrate late relapse can evolve from a pre-leukemic subclone harbouring a non-coding mutation that evades initial chemotherapy.

1.
Teachey
DT
,
O’Connor
D
.
How I treat newly diagnosed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma in children
.
Blood
.
2020
;
135
(
3
):
159
-
166
.
2.
Kunz
JB
,
Rausch
T
,
Bandapalli
OR
, et al
.
Pediatric T-cell lymphoblastic leukemia evolves into relapse by clonal selection, acquisition of mutations and promoter hypomethylation
.
Haematologica
.
2015
;
100
(
11
):
1442
-
1450
.
3.
Tzoneva
G
,
Perez-Garcia
A
,
Carpenter
Z
, et al
.
Activating mutations in the NT5C2 nucleotidase gene drive chemotherapy resistance in relapsed ALL
.
Nat Med
.
2013
;
19
(
3
):
368
-
371
.
4.
Szczepanski
T
,
van der Velden
VHJ
,
Waanders
E
, et al
.
Late recurrence of childhood T-cell acute lymphoblastic leukemia frequently represents a second leukemia rather than a relapse: first evidence for genetic predisposition
.
J Clin Oncol
.
2011
;
29
(
12
):
1643
-
1649
.
5.
Furness
CL
,
Mansur
MB
,
Weston
VJ
, et al
.
The subclonal complexity of STIL-TAL1+ T-cell acute lymphoblastic leukaemia
.
Leukemia
.
2018
;
32
(
9
):
1984
-
1993
.
6.
Mansour
MR
,
Duke
V
,
Foroni
L
, et al
.
Notch-1 mutations are secondary events in some patients with T-cell acute lymphoblastic leukemia
.
Clin Cancer Res
.
2007
;
13
(
23
):
6964
-
6969
.
7.
Albertí-Servera
L
,
Demeyer
S
,
Govaerts
I
, et al
.
Single-cell DNA amplicon sequencing reveals clonal heterogeneity and evolution in T-cell acute lymphoblastic leukemia
.
Blood
.
2021
;
137
(
6
):
801
-
811
.
8.
Wright
G
,
Watt
E
,
Inglott
S
,
Brooks
T
,
Bartram
J
,
Adams
SP
.
Clinical benefit of a high-throughput sequencing approach for minimal residual disease in acute lymphoblastic leukemia
.
Pediatr Blood Cancer
.
2019
;
66
(
8
):
e27787
.
9.
Richter-Pechańska
P
,
Kunz
JB
,
Rausch
T
, et al
.
Pediatric T-ALL type-1 and type-2 relapses develop along distinct pathways of clonal evolution
.
Leukemia
.
2022
;
36
(
7
):
1759
-
1768
.
10.
Yang
F
,
Brady
SW
,
Tang
C
, et al
.
Chemotherapy and mismatch repair deficiency cooperate to fuel TP53 mutagenesis and ALL relapse
.
Nat Cancer
.
2021
;
2
(
8
):
819
-
834
.
11.
Liu
Y
,
Easton
J
,
Shao
Y
, et al
.
The genomic landscape of pediatric and young adult T-lineage acute lymphoblastic leukemia
.
Nat Genet
.
2017
;
49
(
8
):
1211
-
1218
.
12.
O’Connor
D
,
Demeulemeester
J
,
Conde
L
, et al
.
The clinicogenomic landscape of induction failure in childhood and young adult T-cell acute lymphoblastic leukemia
.
J Clin Oncol
.
2023
;
41
(
19
):
3545
-
3556
.
13.
Mansour
MR
,
Abraham
BJ
,
Anders
L
, et al
.
Oncogene regulation. An oncogenic super-enhancer formed through somatic mutation of a noncoding intergenic element
.
Science
.
2014
;
346
(
6215
):
1373
-
1377
.
14.
Liu
Y
,
Li
C
,
Shen
S
, et al
.
Discovery of regulatory noncoding variants in individual cancer genomes by using cis-X
.
Nat Genet
.
2020
;
52
(
8
):
811
-
818
.
15.
Smith
C
,
Goyal
A
,
Weichenhan
D
, et al
.
TAL1 activation in T-cell acute lymphoblastic leukemia: a novel oncogenic 3′ neo-enhancer
.
Haematologica
.
2023
;
108
(
5
):
1259
-
1271
.
16.
Rahman
S
,
Magnussen
M
,
León
TE
, et al
.
Activation of the LMO2 oncogene through a somatically acquired neomorphic promoter in T-cell acute lymphoblastic leukemia
.
Blood
.
2017
;
129
(
24
):
3221
-
3226
.
17.
Abraham
BJ
,
Hnisz
D
,
Weintraub
AS
, et al
.
Small genomic insertions form enhancers that misregulate oncogenes
.
Nat Commun
.
2017
;
8
:
14385
.
18.
Ford
AM
,
Fasching
K
,
Panzer-Grümayer
ER
,
Koenig
M
,
Haas
OA
,
Greaves
MF
.
Origins of “late” relapse in childhood acute lymphoblastic leukemia with TEL-AML1 fusion genes
.
Blood
.
2001
;
98
(
3
):
558
-
564
.
19.
van Delft
FW
,
Horsley
S
,
Colman
S
, et al
.
Clonal origins of relapse in ETV6-RUNX1 acute lymphoblastic leukemia
.
Blood
.
2011
;
117
(
23
):
6247
-
6254
.
20.
Tzoneva
G
,
Dieck
CL
,
Oshima
K
, et al
.
Clonal evolution mechanisms in NT5C2 mutant-relapsed acute lymphoblastic leukaemia
.
Nature
.
2018
;
553
(
7689
):
511
-
514
.
21.
Williams
N
,
Lee
J
,
Mitchell
E
, et al
.
Life histories of myeloproliferative neoplasms inferred from phylogenies
.
Nature
.
2022
;
602
(
7895
):
162
-
168
.
22.
Gallon
R
,
Phelps
R
,
Betts
L
, et al
.
Detection of constitutional mismatch repair deficiency in children and adolescents with acute lymphoblastic leukemia
.
Leuk Lymphoma
.
2023
;
64
(
1
):
217
-
220
.
23.
Larson
RC
,
Lavenir
I
,
Larson
TA
, et al
.
Protein dimerization between Lmo2 (Rbtn2) and Tal1 alters thymocyte development and potentiates T cell tumorigenesis in transgenic mice
.
EMBO J
.
1996
;
15
(
5
):
1021
-
1027
.
You do not currently have access to this content.
Sign in via your Institution