HAEM5:T-prolymphocytic leukaemia: Difference between revisions

|Frequent, Minor diagnostic criteria.<ref name=":6" />PARP inhibitors may be considered as an off-label therapy (NCT03263637)

The most common chromosomal abnormality in T-PLL involves an inversion of chromosome 14, with breakpoints at q11.2 and q32.1, observed in about 60-80% of patients and described as inv(14). Additionally, in 10-20% of cases, there is a translocation t(14;14)(q11.2;q32.1).<ref name=":5" /> <ref name=":7" />[[File:Inv(14)(q11.2q32).png|thumb|Inv(14)(q11.2q32)|alt=|center]]

|ATM loss/mutation; del(11)(q22–q23)

|No

|Minor diagnostic criteria, the most frequent cooperating lesion <ref name=":6" />

|}

Although gene mutations beyond ''TCL1'' family alterations are not yet recognized as diagnostic criteria and remain under investigation for T-PLL, the mutational landscape of T-PLL provides valuable insights. These discoveries open up potential avenues for novel targeted therapies in treating this aggressive form of leukemia.

|''ATM''

|Mutation/deletion, loss of heterozygosity, or biallelic mutation

|Tumor Suppressor Gene

|Common

|D, P, T

|No

|Since alterations at the ''ATM'' locus are found in up to 80% to 90% of T-PLL cases, it can serve as a minor diagnostic criterion.<ref name=":6" /><ref name=":8">{{Cite journal|last=Schrader|first=A.|last2=Crispatzu|first2=G.|last3=Oberbeck|first3=S.|last4=Mayer|first4=P.|last5=Pützer|first5=S.|last6=von Jan|first6=J.|last7=Vasyutina|first7=E.|last8=Warner|first8=K.|last9=Weit|first9=N.|date=2018-02-15|title=Actionable perturbations of damage responses by TCL1/ATM and epigenetic lesions form the basis of T-PLL|url=https://pubmed.ncbi.nlm.nih.gov/29449575|journal=Nature Communications|volume=9|issue=1|pages=697|doi=10.1038/s41467-017-02688-6|issn=2041-1723|pmc=5814445|pmid=29449575}}</ref>

Deletions and mutations of the ATM gene (present in up to 90% of T-PLL cases but typically absent in other mature T-cell malignancies) are considered highly indicative for a diagnosis of suspected TCL1 family-negative T-PLL.<ref name=":8" /><ref name=":3">{{Cite journal|last=Kiel|first=Mark J.|last2=Velusamy|first2=Thirunavukkarasu|last3=Rolland|first3=Delphine|last4=Sahasrabuddhe|first4=Anagh A.|last5=Chung|first5=Fuzon|last6=Bailey|first6=Nathanael G.|last7=Schrader|first7=Alexandra|last8=Li|first8=Bo|last9=Li|first9=Jun Z.|date=2014-08-28|title=Integrated genomic sequencing reveals mutational landscape of T-cell prolymphocytic leukemia|url=https://pubmed.ncbi.nlm.nih.gov/24825865|journal=Blood|volume=124|issue=9|pages=1460–1472|doi=10.1182/blood-2014-03-559542|issn=1528-0020|pmc=4148768|pmid=24825865}}</ref>

<br />

|Loss-of-function

|Tumor Supressor Gene

|Common

|Variable based on gene; Recurrent to Common

|D, P, T

|No

|Targeting this pathway with specific ''JAK/STAT'' pathway inhibitors, has shown promise in preclinical studies and early clinical trials. Combining JAK/STAT inhibitors with other treatments, like BCL-2 inhibitors, may enhance therapeutic efficacy and improve outcomes for T-PLL patients <ref>{{Cite journal|last=Gomez-Arteaga|first=Alexandra|last2=Margolskee|first2=Elizabeth|last3=Wei|first3=Mike T.|last4=van Besien|first4=Koen|last5=Inghirami|first5=Giorgio|last6=Horwitz|first6=Steven|date=2019-07|title=Combined use of tofacitinib (pan-JAK inhibitor) and ruxolitinib (a JAK1/2 inhibitor) for refractory T-cell prolymphocytic leukemia (T-PLL) with a JAK3 mutation|url=https://pubmed.ncbi.nlm.nih.gov/30997845|journal=Leukemia & Lymphoma|volume=60|issue=7|pages=1626–1631|doi=10.1080/10428194.2019.1594220|issn=1029-2403|pmc=8162842|pmid=30997845}}</ref><ref>{{Cite journal|url=https://ashpublications.org/blood/article/126/23/5486/134544/Refractory-TCell-Prolymphocytic-Leukemia-with-JAK3|doi=10.1182/blood.v126.23.5486.5486}}</ref>

|Both oncogene and Tumor Suppressor Gene

|Recurrent

|Unknown

|''EZH2'' inhibitors like tazemetostat have shown efficacy in other hematologic malignancies, providing a rationale for off-label use in T-PLL

|Loss-of-function

|Tumor Supressor Gene

|Rare

|Unknown

|Loss-of-function

|Tumor Supressor Gene

|Recurrent

|D, P

|''SAMHD1'' mutations may indicate a defective DNA damage response and aggressive disease <ref name=":4">{{Cite journal|last=Johansson|first=Patricia|last2=Klein-Hitpass|first2=Ludger|last3=Choidas|first3=Axel|last4=Habenberger|first4=Peter|last5=Mahboubi|first5=Bijan|last6=Kim|first6=Baek|last7=Bergmann|first7=Anke|last8=Scholtysik|first8=René|last9=Brauser|first9=Martina|date=2018-01-19|title=SAMHD1 is recurrently mutated in T-cell prolymphocytic leukemia|url=https://pubmed.ncbi.nlm.nih.gov/29352181|journal=Blood Cancer Journal|volume=8|issue=1|pages=11|doi=10.1038/s41408-017-0036-5|issn=2044-5385|pmc=5802577|pmid=29352181}}</ref>

|Loss-of-function

|Tumor Supressor Gene

|Rare

|Unknown

|Variable inactivating/loss of function mutations

|Tumor Supressor Gene

|Rare

|P (may portend resistance to therapy)

|}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.

See references.

 

 

 

 

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