Oncogenomic profiling in infant–toddler T‐ALL identifies NKX2 family genes as drivers linked to favorable outcomes

• Published in: HemaSphere Vol. 9; no. 5; pp. e70154 - n/a
• Main Authors: Delafoy, Manon, Balducci, Estelle, Simonin, Mathieu, Pinton, Antoine, Charbonnier, Guillaume, Courtois, Lucien, Lhermitte, Ludovic, Gillet, Camille, Féroul, Mélanie, Touzart, Aurore, Cieslak, Agata, Smith, Charlotte, Courgeon, Marianne, Wiber, Margaux, Mercher, Thomas, Latour, Sylvain, Arnoux, Isabelle, Saultier, Paul, Rohrlich, Pierre‐Simon, Bodet, Damien, Grardel, Nathalie, Lubnau, Marion, Pellier, Isabelle, Thouvenin, Sandrine, Garnier, Nathalie, Pastoret, Cédric, Brethon, Benoit, Petit, Arnaud, Macintyre, Elizabeth, Baruchel, André, Asnafi, Vahid
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.05.2025; Wiley
• ISSN: 2572-9241; 2572-9241
• DOI: 10.1002/hem3.70154

T‐cell acute lymphoblastic leukemia (T‐ALL) is a rare and aggressive hematological malignancy primarily affecting adolescents and young adults and is scarce in infants and toddlers under age 3. Unlike B‐ALL, T‐ALL in this young population remains poorly characterized due to limited data and lacks evidence‐based guidelines to help clinicians determine the optimal treatment approach. In this study, we conducted a comprehensive genetic analysis of infant/toddler T‐ALL cases from a French national cohort, utilizing high‐throughput targeted sequencing, optical genome mapping, and RNA sequencing. Genetic analysis revealed the absence of TLX1/3 dysregulation. Instead, we identified a significant prevalence of NKX2 rearrangements (n = 9, 33%), co‐occurring with MYB alterations (n = 5/9) or chromothripsis‐like events (n = 3/9). Additional findings included TAL1/‐like anomalies (30%), STAG2::LMO2 (15%), ETS rearrangements (15%), and rarely, KMT2A rearrangements (7%). Comparative analyses with 245 patients aged 3–18 years, enrolled in the pediatric FRALLE2000T French protocol, underscored the distinct clinical and genetic profiles of infants/toddlers. Despite presenting with higher rates of hyperleukocytosis and slower responses to treatment, they demonstrated comparable survival outcomes to older pediatric patients, with a 5‐year overall survival (OS) rate of 75.4% (95% confidence interval [CI]: 60.0%–94.8%) versus 75.2% (95% CI: 69.8%–81.1%), p = 0.86. Notably, alterations in NKX2, KMT2A, and STAG2::LMO2 delineated oncogenic subgroups exhibiting a remarkable 100% OS rate, while patients with TAL1 or ETS dysregulation experienced less favorable outcomes. This was further supported by analyses of data from the COG AALL0434 trial, enhancing our understanding of T‐ALL in infants/toddlers. Large‐scale collaborative studies remain essential to confirm these findings and refine treatment strategies.