IKZF1plus is a frequent biomarker of adverse prognosis in Mexican pediatric patients with B-acute lymphoblastic leukemia
Authors: Garcia-Solorio Joaquin , Núñez-Enriquez Juan Carlos , Jiménez-Olivares Marco , Flores-Lujano Janet , Flores-Espino Fernanda , Molina-Garay Carolina , Cervera Alejandra , Casique-Aguirre Diana , Peñaloza-Gonzalez José Gabriel , Baños-Lara Ma. Del Rocío , García-Soto Ángel , Galván-Díaz César Alejandro , Olaya-Vargas Alberto , Aguilar Hilario Flores , Mata-Rocha Minerva , Garrido-Hernández Miguel Ángel , Solís-Poblano Juan Carlos , Luna-Silva Nuria Citlalli , Cano-Cuapio Lena Sarahi , Aristil-Chery Pierre Mitchel , Herrera-Quezada Fernando , Carrillo-Sanchez Karol , Muñoz-Rivas Anallely , Flores-Lagunes Luis Leonardo , Mendoza-Caamal Elvia Cristina , Villegas-Torres Beatriz Eugenia , González-Osnaya Vincent , Jiménez-Hernández Elva , Torres-Nava José Refugio , Martín-Trejo Jorge Alfonso , Gutiérrez-Rivera María de Lourdes , Espinosa-Elizondo Rosa Martha , Merino-Pasaye Laura Elizabeth , Pérez-Saldívar María Luisa , Jiménez-Morales Silvia , Curiel-Quesada Everardo , Rosas-Vargas Haydeé , Mejía-Arangure Juan Manuel , Alaez-Verson Carmen 
Published: April 2024

BackgroundRecurrent genetic alterations contributing to leukemogenesis have been identified in pediatric B-cell Acute Lymphoblastic Leukemia (B-ALL), and some are useful for refining classification, prognosis, and treatment selection. IKZF1plus is a complex biomarker associated with a poor prognosis. It is characterized by IKZF1 deletion coexisting with PAX5, CDKN2A/2B, or PAR1 region deletions. The mutational spectrum and clinical impact of these alterations have scarcely been explored in Mexican pediatric patients with B-ALL. Here, we report the frequency of the IKZF1plus profile and the mutational spectrum of IKZF1, PAX5, CDKN2A/2B, and ERG genes and evaluate their impact on overall survival (OS) in a group of patients with B-ALL.MethodsA total of 206 pediatric patients with de novo B-ALL were included. DNA was obtained from bone marrow samples at diagnosis before treatment initiation. A custom-designed next-generation sequencing panel was used for mutational analysis. Kaplan-Meier analysis was used for OS estimation.ResultsWe identified the IKZF1plus profile in 21.8% of patients, which was higher than that previously reported in other studies. A significantly older age (p=0.04), a trend toward high-risk stratification (p=0.06), and a decrease in 5-year Overall Survival (OS) (p=0.009) were observed, although heterogeneous treatment protocols in our cohort would have impacted OS. A mutation frequency higher than that reported was found for IKZF1 (35.9%) and CDKN2A/2B (35.9%) but lower for PAX5 (26.6%). IKZF1MUT group was older at diagnosis (p=0.0002), and most of them were classified as high-risk (73.8%, p=0.02), while patients with CDKN2A/2BMUT had a higher leukocyte count (p=0.01) and a tendency toward a higher percentage of blasts (98.6%, &gt;50% blasts, p=0.05) than the non-mutated patients. A decrease in OS was found in IKZF1MUT and CDKN2A/2BMUT patients, but the significance was lost after IKZF1plus was removed.DiscussionOur findings demonstrated that Mexican patients with B-ALL have a higher prevalence of genetic markers associated with poor outcomes. Incorporating genomic methodologies into the diagnostic process, a significant unmet need in low- and mid-income countries, will allow a comprehensive identification of relevant alterations, improving disease classification, treatment selection, and the general outcome.