Prognostic Implications of Mutations in NOTCH1 and FBXW7 in Childhood T-ALL Treated According to the NOPHO ALL-1992 and ALL-2000 Protocols

Linda Fogelstrand, Anna Staffas, Carina Wasslavik, Helene Sjogren, Stefan Soderhall, Britt-Marie Frost, Erik Forestier, Sofie Degerman, Mikael Behrendtz, Jesper Heldrup, Kristina Karrman, Bertil Johansson, Mats Heyman, Jonas Abrahamsson, Lars Palmqvist

Research output: Contribution to journalArticlepeer-review


BackgroundIn children, T-cell acute lymphoblastic leukemia (T-ALL) has inferior prognosis compared with B-cell precursor ALL. In order to improve survival, individualized treatment strategies and thus risk stratification algorithms are warranted, ideally already at the time of diagnosis. ProcedureWe analyzed the frequency and prognostic implication of mutations in NOTCH1 and FBXW7 in 79 cases of Swedish childhood T-ALL treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL-1992 and ALL-2000 protocols. In a subgroup of patients, we also investigated the functional relevance of NOTCH1 mutations measured as expression of the HES1, MYB, and MYC genes. ResultsForty-seven of the cases (59%) displayed mutations in NOTCH1 and/or FBXW7. There was no difference in overall (P=0.14) or event-free survival (EFS) (P=0.10) in patients with T-ALL with mutation(s) in NOTCH1/FBXW7 compared with patients with T-ALL without mutations in any of these genes. T-ALL carrying NOTCH1 mutations had increased HES1 and MYB mRNA expression (HES1 9.21.9 (mean +/- SEM), MYB 8.7 +/- 0.8 (mean +/- SEM)) compared to T-ALL with wild-type NOTCH1 (HES1 1.8 +/- 0.7, MYB 5.1 +/- 1.2, P=0.02 and 0.008, respectively). In cases of T-ALL with high HES1 expression, improved overall (P=0.02) and EFS (P=0.028) was seen. ConclusionsIncreased NOTCH activity, reflected by increased HES1 expression, is associated with improved outcome in pediatric T-ALL, but its role as a diagnostic tool or a therapeutic target in future clinical treatment protocols remains to be elucidated. Pediatr Blood Cancer 2014;61:424-430. (c) 2013 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)424-430
JournalPediatric Blood & Cancer
Issue number3
Publication statusPublished - 2014

Subject classification (UKÄ)

  • Pediatrics

Free keywords

  • cytogenetics and molecular genetics
  • FBXW7
  • NOTCH1
  • pediatric acute
  • lymphoblastic leukemia
  • prognosis


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