We present the molecular landscape of pediatric acute myeloid leukemia (AML) and characterize nearly 1,000 participants in Children's Oncology Group (COG) AML trials. The COG-National Cancer Institute (NCI) TARGET AML initiative assessed cases by whole-genome, targeted DNA, mRNA and microRNA sequencing and CpG methylation profiling. Validated DNA variants corresponded to diverse, infrequent mutations, with fewer than 40 genes mutated in >2% of cases. In contrast, somatic structural variants, including new gene fusions and focal deletions of MBNL1, ZEB2 and ELF1, were disproportionately prevalent in young individuals as compared to adults. Conversely, mutations in DNMT3A and TP53, which were common in adults, were conspicuously absent from virtually all pediatric cases. New mutations in GATA2, FLT3 and CBL and recurrent mutations in MYC-ITD, NRAS, KRAS and WT1 were frequent in pediatric AML. Deletions, mutations and promoter DNA hypermethylation convergently impacted Wnt signaling, Polycomb repression, innate immune cell interactions and a cluster of zinc finger-encoding genes associated with KMT2A rearrangements. These results highlight the need for and facilitate the development of age-tailored targeted therapies for the treatment of pediatric AML.

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Persistent URL dx.doi.org/10.1038/nm.4439, hdl.handle.net/1765/104053
Journal Nature Medicine

ERRATUM: In the version of this article initially published online, Figure 1a has two black boxes in the key that are labeled as ‘Unknown’; these boxes should be white, matching the segments in the donut charts shown below the key.
The error has been corrected in the print, PDF and HTML versions of this article.

Bolouri, H. (Hamid), Farrar, J.E. (Jason E.), Triche, T. (Timothy), Ries, R.E. (Rhonda E.), Lim, E.L. (Emilia L.), Alonzo, T.A, … Meshinchi, S. (2018). The molecular landscape of pediatric acute myeloid leukemia reveals recurrent structural alterations and age-specific mutational interactions. Nature Medicine, 24(1), 103–112. doi:10.1038/nm.4439