Age and DNA methylation subgroup as potential independent risk factors for treatment stratification in children with atypical teratoid/rhabdoid tumors.

Michael C. Frühwald, Martin Hasselblatt, Karolina Nemes, Susanne Bens, Mona Steinbügl, Pascal D. Johann, Kornelius Kerl, Peter Hauser, Eduardo Quiroga, Palma Solano-Paez, Veronica Biassoni, Maria Joao Gil-da-Costa, Martha Perek-Polnik, Marianne van de Wetering, David Sumerauer, Jane Pears, Niklas Stabell, Stefan Holm, Heinz Hengartner, Nicolas U. GerberMichael Grotzer, Joachim Boos, Martin Ebinger, Stefan Tippelt, Werner Paulus, Rhoikos Furtwängler, Pablo Hernáiz-Driever, Harald Reinhard, Stefan Rutkowski, Paul-Gerhardt Schlegel, Irene Schmid, Rolf-Dieter Kortmann, Beate Timmermann, Monika Warmuth-Metz, Uwe Kordes, Joachim Gerss, Karsten Nysom, Reinhard Schneppenheim, Reiner Siebert, Marcel Kool, Norbert Graf

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BACKGROUND: Controversy exists as to what may be defined as standard of care (including markers for stratification) for patients with atypical teratoid/rhabdoid tumors (ATRTs). The European Rhabdoid Registry (EU-RHAB) recruits uniformly treated patients and offers standardized genetic and DNA methylation analyses. METHODS: Clinical, genetic, and treatment data of 143 patients from 13 European countries were analyzed (2009-2017). Therapy consisted of surgery, anthracycline-based induction, and either radiotherapy or high dose chemotherapy following a consensus among European experts. Fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, and sequencing were employed for assessment of somatic and germline mutations in SWItch/sucrose nonfermentable related, matrix associated, actin dependent regulator of chromatin, subfamily B (SMARCB1). Molecular subgroups (ATRT-SHH, ATRT-TYR, and ATRT-MYC) were determined using DNA methylation arrays, resulting in profiles of 84 tumors. RESULTS: Median age at diagnosis of 67 girls and 76 boys was 29.5 months. Five-year overall survival (OS) and event-free survival (EFS) were 34.7 ± 4.50.5 ± 4.2 respectively. Tumors displayed allelic partial/whole gene deletions (66 122/186 alleles) or single nucleotide variants (34 64/186 alleles) of SMARCB1. Germline mutations were detected in 2630/117). The patient cohort consisted of 47SHH (39/84), 33TYR (28/84), and 20MYC (17/84). Age textless1 year, non-TYR signature (ATRT-SHH or -MYC), metastatic or synchronous tumors, germline mutation, incomplete remission, and omission of radiotherapy were negative prognostic factors in univariate analyses (P textless 0.05). An adjusted multivariate model identified age textless1 year and a non-TYR signature as independent negative predictors of OS: high risk (textless1 y + non-TYR; 5-y OS = 0, intermediate risk (textless1 y + ATRT-TYR or ≥1 y + non-TYR; 5-y OS = 32.5 ± 8.7, and standard risk (≥1 y + ATRT-TYR, 5-y OS = 71.5 ± 12.2. CONCLUSIONS: Age and molecular subgroup status are independent risk factors for survival in children with ATRT. Our model warrants validation within future clinical trials.
Original languageEnglish
Issue number7
Publication statusPublished - Jul 1 2020


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