Deciphering KRAS and NRAS mutated clone dynamics in MLL-AF4 paediatric leukaemia by ultra deep sequencing analysis

Luca Trentin, Silvia Bresolin, Emanuela Giarin, Michela Bardini, Valentina Serafin, Benedetta Accordi, Franco Fais, Claudya Tenca, Paola De Lorenzo, Maria Grazia Valsecchi, Giovanni Cazzaniga, Geertruy Te Kronnie, Giuseppe Basso

Research output: Contribution to journalArticlepeer-review


To induce and sustain the leukaemogenic process, MLL-AF4+ leukaemia seems to require very few genetic alterations in addition to the fusion gene itself. Studies of infant and paediatric patients with MLL-AF4+ B cell precursor acute lymphoblastic leukaemia (BCP-ALL) have reported mutations in KRAS and NRAS with incidences ranging from 25 to 50%. Whereas previous studies employed Sanger sequencing, here we used next generation amplicon deep sequencing for in depth evaluation of RAS mutations in 36 paediatric patients at diagnosis of MLL-AF4+ leukaemia. RAS mutations including those in small sub-clones were detected in 63.9% of patients. Furthermore, the mutational analysis of 17 paired samples at diagnosis and relapse revealed complex RAS clone dynamics and showed that the mutated clones present at relapse were almost all originated from clones that were already detectable at diagnosis and survived to the initial therapy. Finally, we showed that mutated patients were indeed characterized by a RAS related signature at both transcriptional and protein levels and that the targeting of the RAS pathway could be of beneficial for treatment of MLL-AF4+ BCP-ALL clones carrying somatic RAS mutations.

Original languageEnglish
Article number34449
JournalScientific Reports
Publication statusPublished - Oct 4 2016

ASJC Scopus subject areas

  • General


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