2009.08.20 – Novel TET2 Mutations Associated With UPD4q24 in Myelodysplastic Syndrome


Originally published as JCO Early Release 10.1200/JCO.2009.22.6985 on June 15 2009

Journal of Clinical Oncology, Vol 27, No 24 (August 20), 2009: pp. 4002-4006

© 2009 American Society of Clinical Oncology.

Leukemia and Bone Marrow Transplantation

Novel TET2 Mutations Associated With UPD4q24 in Myelodysplastic Syndrome

Azim M. Mohamedali, Alexander E. Smith, Joop Gaken, Nicholas C. Lea, Syed A. Mian, Nigel B. Westwood, Corinna Strupp, Norbert Gattermann, Ulrich Germing, Ghulam J. Mufti

From the Department of Haematological Medicine, King’s College London School of Medicine, London, United Kingdom; and Klinik für Hämatologie, Onkologie und Klinische Immunologie, Heinrich-Heine-Universität, Düsseldorf, Germany.

Corresponding author: Ghulam J. Mufti, DM, FRCP, FRCPath, Department of Haematological Medicine, King’s College London School of Medicine, The Rayne Institute, 123 Coldharbour Lane, London, SE5 9NU, United Kingdom; e-mail: ghulam.mufti@kcl.ac.uk.

Purpose Cryptic chromosomal aberrations, such as regions of uniparental disomy (UPD), have been shown to harbor homozygous mutations and are a common feature in myelodysplastic syndrome (MDS). We investigated the sequence integrity of 4q24 candidate tumor suppressor gene TET2 in MDS patients with UPD on chromosome 4.

Patients and Methods The coding exons of TET2 were analyzed by 454 deep sequencing and Sanger sequencing in nine patients with UPD on 4q. Four patients had refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS) and UPD4q24, and five patients (refractory anemia with excess blasts-II, n = 1; 5q– syndrome, n = 1; RCMD-RS, n = 1; refractory anemia, n = 1; refractory cytopenia with multilineage dysplasia, n = 1) had no UPD4q24.

Results Mutations on TET2 were identified in all four patients with UPD4q24. These were localized to exons 3, 6, and 9 and resulted in two premature stop codons, one frameshift mutation, and one cysteine to glycine amino acid change. Mutant clone size varied between 30% and 85%. One patient with UPD outside of q24 (UPD4q28.3) displayed additional TET2 mutations, but these were at low clonal levels (13%, 4%, and 4% for a silent mutation, a 180-base pair deletion in exon 3, and a lysine to phenylalanine substitution in exon 11, respectively). The other patients who did not have UPD4q24 did not have verifiable TET2 mutations.

Conclusion Our data identify novel TET2 mutations in a dominant clone in patients with UPD4q24. The presence of UPD4q24 and mutations in RCMD-RS patients may suggest specificity to this subtype. Our preliminary results need to be confirmed in a large cohort of all MDS subtypes.

A.M.M. and A.E.S. contributed equally to this study.

Supported in part by a Young Investigators Grant Award (2007; A.M.M.) from the Myelodysplastic Syndromes Foundation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.