Table 1.

Characteristics relevant to RUNX1-, ETV6-, and ANKRD26-driven HPDs

RUNX1ETV6ANKRD26
Full gene name RUNX family transcription factor 1 ETS variant transcription factor 6 Ankyrin-repeat domain 26 
No. of exons 34 
Transcript (HGVS reference) NM_001754.4 NM_001987.5 NM_014915.3 
Protein (HGVS reference) NP_001745.2 NP_001978.1 NP_055730.2 
Protein length (HGVS reference), amino acids 480  452 1710 
Gene function Transcription factor: DNA binding, activator, repressor Transcription factor: DNA binding, repressor Ankyrin-repeat protein-protein interactions: MAPK/extracellular signal-regulated kinase signaling 
Disease association OMIM:601399; MONDO:0011071 OMIM 616216; MONDO:0014536 OMIM:188000, MONDO:0008555 
First phenotype description 1969 Unknown 1965 
First genetic description 1999 2015 2011 
Mode of inheritance AD AD AD 
Germ line variants Missense, nonsense, frameshift, deletions, duplications, splicing, structural variants Missense, nonsense, frameshift, deletions, structural variants 5′ UTR variants 
Disease mechanism Haploinsufficiency and dominant-negative Haploinsufficiency and dominant-negative Loss of RUNX1-, FLI1-, and ETS-binding sites in 5′ UTR, gene derepression 
Platelet levels, ×109/L 70-145 >75 <150 
Platelet function Aspirin-like defect on platelet aggregometry and α/δ-granule deficits Normal platelet size and variable mean platelet volume. Abnormal platelet aggregation, α granules deficits Platelet size is often unchanged 
Non-HM hematological phenotypes Thrombocytopenia Thrombocytopenia Thrombocytopenia, some reports of red cell macrocytosis, erythrocytosis, neutropenia 
HMs MDS, AML, T-cell ALL,
T-NHL, CLL, HCL 
B-ALL, MPAL, MN, MDS, AML, multiple myeloma, CMML MDS, AML, CML, CLL 
HM cumulative risk 43% by 50 y 30% 8% lifetime risk 
HM median age of onset, y 29 11 33 
HM age range, y 2-72 2-82 1-84 
Other phenotypes Eczema/psoriasis Not reported Not available 
Non-HM malignancies Breast, prostate, bone, gastric, pancreas, and skin cancer Melanoma, colorectal, breast, kidney, and skin and meningioma cancer Prostate, breast, and colon cancer 
Somatic variant pattern Loss of RUNX1 WT allele in myeloid. Lymphoid driver variants in lymphoid disease Hyperdiploid. Loss of ETV6 WT allele Not well described, add more detail 
Mouse models and phenotypes LOF and FPD-MM missense variants/homozygous KO and FPD-MM are embryonic lethal/Runx1R188Q/+ mice: reduced platelet function, defect DNA-damage response, myeloid expansion in the BM LOF allele, Etv6 P214L knockin mice/KO embryonic lethal/Etv6 P214L homozygous mice: decreased platelet counts, impaired megakaryocyte maturation, and defect in platelet activation KO allele (not appropriate for disease). No hematological abnormalities 
RUNX1ETV6ANKRD26
Full gene name RUNX family transcription factor 1 ETS variant transcription factor 6 Ankyrin-repeat domain 26 
No. of exons 34 
Transcript (HGVS reference) NM_001754.4 NM_001987.5 NM_014915.3 
Protein (HGVS reference) NP_001745.2 NP_001978.1 NP_055730.2 
Protein length (HGVS reference), amino acids 480  452 1710 
Gene function Transcription factor: DNA binding, activator, repressor Transcription factor: DNA binding, repressor Ankyrin-repeat protein-protein interactions: MAPK/extracellular signal-regulated kinase signaling 
Disease association OMIM:601399; MONDO:0011071 OMIM 616216; MONDO:0014536 OMIM:188000, MONDO:0008555 
First phenotype description 1969 Unknown 1965 
First genetic description 1999 2015 2011 
Mode of inheritance AD AD AD 
Germ line variants Missense, nonsense, frameshift, deletions, duplications, splicing, structural variants Missense, nonsense, frameshift, deletions, structural variants 5′ UTR variants 
Disease mechanism Haploinsufficiency and dominant-negative Haploinsufficiency and dominant-negative Loss of RUNX1-, FLI1-, and ETS-binding sites in 5′ UTR, gene derepression 
Platelet levels, ×109/L 70-145 >75 <150 
Platelet function Aspirin-like defect on platelet aggregometry and α/δ-granule deficits Normal platelet size and variable mean platelet volume. Abnormal platelet aggregation, α granules deficits Platelet size is often unchanged 
Non-HM hematological phenotypes Thrombocytopenia Thrombocytopenia Thrombocytopenia, some reports of red cell macrocytosis, erythrocytosis, neutropenia 
HMs MDS, AML, T-cell ALL,
T-NHL, CLL, HCL 
B-ALL, MPAL, MN, MDS, AML, multiple myeloma, CMML MDS, AML, CML, CLL 
HM cumulative risk 43% by 50 y 30% 8% lifetime risk 
HM median age of onset, y 29 11 33 
HM age range, y 2-72 2-82 1-84 
Other phenotypes Eczema/psoriasis Not reported Not available 
Non-HM malignancies Breast, prostate, bone, gastric, pancreas, and skin cancer Melanoma, colorectal, breast, kidney, and skin and meningioma cancer Prostate, breast, and colon cancer 
Somatic variant pattern Loss of RUNX1 WT allele in myeloid. Lymphoid driver variants in lymphoid disease Hyperdiploid. Loss of ETV6 WT allele Not well described, add more detail 
Mouse models and phenotypes LOF and FPD-MM missense variants/homozygous KO and FPD-MM are embryonic lethal/Runx1R188Q/+ mice: reduced platelet function, defect DNA-damage response, myeloid expansion in the BM LOF allele, Etv6 P214L knockin mice/KO embryonic lethal/Etv6 P214L homozygous mice: decreased platelet counts, impaired megakaryocyte maturation, and defect in platelet activation KO allele (not appropriate for disease). No hematological abnormalities 

AD, autosomal dominant; CLL, chronic lymphocytic leukemia; CML, chronic myeloid leukemia; CMML, chronic myelomonocytic leukemia; HCL, hairy cell leukemia; HGVS, Human Genome Variation Society; LOF, loss-of-function; MPAL, mixed phenotype leukemia; T-NHL, T-cell non-Hodgkin lymphoma; WT, wild-type; y, year.

Also known as RUNX1c isoform and is the predominant isoform in hematopoietic cells.

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