RUNX1-mutated families show phenotype heterogeneity and a somatic mutation profile unique to germline predisposed AML
Anna Brown, Peer Arts, Catherine Carmichael, Milena Babic, Julia Dobbins, Chan‐Eng Chong, Andreas Schreiber, Jinghua Feng, Kerry Phillips, Paul Wang, Thuong Ha, Claire C. Homan, Sarah L. King‐Smith, Lesley Rawlings, Cassandra Vakulin, Andrew Dubowsky, Jessica Burdett, Sarah Moore, Grace McKavanagh, Denae Henry, Amanda Wells, Belinda Mercorella, Mario Nicola, Jeffrey C. Suttle, Ella Wilkins, Xiaochun Li, Joëlle Michaud, Peter J Brautigan, Ping Cannon, Meryl Altree, Louise Jaensch, Miriam Fine, Carolyn M Butcher, Richard J. D’Andrea, Ian D. Lewis, Devendra Hiwase, Elli Papaemmanuil, Marshall S. Horwitz, Georges Natsoulis, Hugh Young Rienhoff, Nigel Patton, Sally Mapp, Rachel Susman, Susan Morgan, Julian Cooney, Mark S. Currie, Uday Popat, Tilmann Bochtler, Shai Izraeli, Kenneth F. Bradstock, Lucy A. Godley, Alwin Krämer, Stefan Fröhling, Andrew H. Wei, Cecily Forsyth, Helen Mar Fan, Nicola Poplawski, Christopher N Hahn, Hamish S. Scott
Abstract
First reported in 1999, germline runt-related transcription factor 1 (RUNX1) mutations are a well-established cause of familial platelet disorder with predisposition to myeloid malignancy (FPD-MM). We present the clinical phenotypes and genetic mutations detected in 10 novel RUNX1-mutated FPD-MM families. Genomic analyses on these families detected 2 partial gene deletions, 3 novel mutations, and 5 recurrent mutations as the germline RUNX1 alterations leading to FPD-MM. Combining genomic data from the families reported herein with aggregated published data sets resulted in 130 germline RUNX1 families, which allowed us to investigate whether specific germline mutation characteristics (type, location) could explain the large phenotypic heterogeneity between patients with familial platelet disorder and different HMs. Comparing the somatic mutational signatures between the available familial (n = 35) and published sporadic (n = 137) RUNX1-mutated AML patients showed enrichment for somatic mutations affecting the second RUNX1 allele and GATA2. Conversely, we observed a decreased number of somatic mutations affecting NRAS, SRSF2, and DNMT3A and the collective genes associated with CHIP and epigenetic regulation. This is the largest aggregation and analysis of germline RUNX1 mutations performed to date, providing a unique opportunity to examine the factors underlying phenotypic differences and disease progression from FPD to MM.