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Blood, 15 April 2008, Vol. 111, No. 8, pp. 4322-4328.
Prepublished online as a Blood First Edition Paper on January 2, 2008; DOI 10.1182/blood-2007-06-095075.


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NEOPLASIA

Leukemia-associated NF1 inactivation in patients with pediatric T-ALL and AML lacking evidence for neurofibromatosis

Brian V. Balgobind1,*, Pieter Van Vlierberghe1,*, Ans M. W. van den Ouweland2, H. Berna Beverloo2, Joan N. R. Terlouw-Kromosoeto2, Elisabeth R. van Wering3, Dirk Reinhardt4, Martin Horstmann5, Gertjan J. L. Kaspers6, Rob Pieters1, C. Michel Zwaan1, Marry M. Van den Heuvel-Eibrink1,{dagger}, and Jules P. P. Meijerink1,{dagger}

1 Department of Pediatric Oncology/Hematology, Erasmus MC / Sophia Children's Hospital, Rotterdam, The Netherlands; 2 Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands; 3 Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands; 4 Acute Myeloid Leukemia–Berlin-Frankfurt-Munster (AML-BFM) Study Group, Hannover, Germany; 5 German Co-operative study group for childhood acute lymphoblastic leukemia (COALL), Hamburg, Germany; 6 Department of Pediatric Oncology/Hematology, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder caused by mutations in the NF1 gene. Patients with NF1 have a higher risk to develop juvenile myelomonocytic leukemia (JMML) with a possible progression toward acute myeloid leukemia (AML). In an oligo array comparative genomic hybridization–based screening of 103 patients with pediatric T-cell acute lymphoblastic leukemia (T-ALL) and 71 patients with MLL-rearranged AML, a recurrent cryptic deletion, del(17)(q11.2), was identified in 3 patients with T-ALL and 2 patients with MLL-rearranged AML. This deletion has previously been described as a microdeletion of the NF1 region in patients with NF1. However, our patients lacked clinical NF1 symptoms. Mutation analysis in 4 of these del(17)(q11.2)-positive patients revealed that mutations in the remaining NF1 allele were present in 3 patients, confirming its role as a tumor-suppressor gene in cancer. In addition, NF1 inactivation was confirmed at the RNA expression level in 3 patients tested. Since the NF1 protein is a negative regulator of the RAS pathway (RAS-GTPase activating protein), homozygous NF1 inactivation represent a novel type I mutation in pediatric MLL-rearranged AML and T-ALL with a predicted frequency that is less than 10%. NF1 inactivation may provide an additional proliferative signal toward the development of leukemia.


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