Children with Downs syndrome (DS) have an increased risk of developing acute lymphoblastic leukemia (ALL) and have a low frequency of established genetic aberrations. We aimed to determine which genetic abnormalities are involved in DS ALL. We studied the frequency and prognostic value of deletions in B-cell development genes and aberrations of janus kinase 2 (JAK2) and cytokine receptor-like factor 2 (CRLF2) using array-comparative genomic hybridization, and multiplex ligation-dependent probe amplification in a population-based cohort of 34 Dutch Childhood Oncology Group DS ALL samples. A population-based cohort of 88 DS samples from the UK trials was used to validate survival estimates for IKZF1 and CRLF2 abnormalities. In total, 50% of DS ALL patients had ≥1 deletion in the B-cell development genes: PAX5 (12%), VPREB1 (18%) and IKZF1 (35%). JAK2 was mutated in 15% of patients, genomic CRLF2 rearrangements in 62%. Outcome was significantly worse in patients with IKZF1 deletions (6-year event-free survival (EFS) 45±16% vs 95±4%; P=0.002), which was confirmed in the validation cohort (6-year EFS 21±12% vs 58±11%; P=0.002). This IKZF1 deletion was a strong independent predictor for outcome (hazard ratio EFS 3.05; P=0.001). Neither CRLF2 nor JAK2 were predictors for worse prognosis. If confirmed in prospective series, IKZF1 deletions may be used for risk-group stratification in DS ALL.

ALL, CRLF2, Down's syndrome, IKZF1, Prognosis,
Department of Pediatrics

Buitenkamp, T.D, Pieters, R, Gallimore, P, van der Veer, A, Meijerink, J.P.P, Beverloo, H.B, … Zwaan, C.M. (2012). Outcome in children with Down's syndrome and acute lymphoblastic leukemia: Role of IKZF1 deletions and CRLF2 aberrations. Leukemia, 26(10), 2204–2211. doi:10.1038/leu.2012.84