1. Genomic characteristics and prognostic significance of co-mutated ASXL1/SRSF2 acute myeloid leukemia.
- Author
-
Richardson, Daniel, Swoboda, David, Moore, Dominic, Johnson, Steven, Chan, Onyee, Galeotti, Jonathan, Esparza, Sonia, Hussaini, Mohammad, Van Deventer, Hendrick, Foster, Matthew, Coombs, Catherine, Montgomery, Nathan, Sallman, David, and Zeidner, Joshua
- Subjects
Adult ,Aged ,Aged ,80 and over ,Alleles ,Cell Transformation ,Neoplastic ,Cocarcinogenesis ,Female ,High-Throughput Nucleotide Sequencing ,Humans ,Kaplan-Meier Estimate ,Leukemia ,Myeloid ,Acute ,Male ,Middle Aged ,Mutation ,Prognosis ,Repressor Proteins ,Retrospective Studies ,Serine-Arginine Splicing Factors - Abstract
The ASXL1 and SRSF2 mutations in AML are frequently found in patients with preexisting myeloid malignancies and are individually associated with poor outcomes. In this multi-institutional retrospective analysis, we assessed the genetic features and clinical outcomes of 43 patients with ASXL1mut SRSF2mut AML and compared outcomes to patients with either ASXL1 (n = 57) or SRSF2 (n = 70) mutations. Twenty-six (60%) had secondary-AML (s-AML). Variant allele fractions suggested that SRSF2 mutations preceded ASXL1 mutational events. Median overall survival (OS) was 7.0 months (95% CI:3.8,15.3) and was significantly longer in patients with de novo vs s-AML (15.3 vs 6.4 months, respectively; P = .04 on adjusted analysis). Compared to ASXL1mut SRSF2wt and ASXL1wt SRSF2mut , co-mutated patients had a 1.4 and 1.6 times increase in the probability of death, respectively (P = .049), with a trend towards inferior OS (median OS = 7.0 vs 11.5 vs 10.9 months, respectively; P = .10). Multivariable analysis suggests this difference in OS is attributable to the high proportion of s-AML patients in the co-mutated cohort (60% vs 32% and 23%, respectively). Although this study is limited by the retrospective data collection and the relatively small sample size, these data suggest that ASXL1mut SRSF2mut AML is a distinct subgroup of AML frequently associated with s-AML and differs from ASXL1mut SRSF2wt /ASXL1wt SRSF2mut with respect to etiology and leukemogenesis.
- Published
- 2021