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International Consensus Definition of DNA Methylation Subgroups in Juvenile Myelomonocytic Leukemia.


ABSTRACT:

Purpose

Known clinical and genetic markers have limitations in predicting disease course and outcome in juvenile myelomonocytic leukemia (JMML). DNA methylation patterns in JMML have correlated with outcome across multiple studies, suggesting it as a biomarker to improve patient stratification. However, standardized approaches to classify JMML on the basis of DNA methylation patterns are lacking. We, therefore, sought to define an international consensus for DNA methylation subgroups in JMML and develop classification methods for clinical implementation.

Experimental design

Published DNA methylation data from 255 patients with JMML were used to develop and internally validate a classifier model. Accuracy across platforms (EPIC-arrays and MethylSeq) was tested using a technical validation cohort (32 patients). The suitability of both methods for single-patient classification was demonstrated using an independent cohort (47 patients).

Results

Analysis of pooled, published data established three DNA methylation subgroups as a de facto standard. Unfavorable prognostic parameters (PTPN11 mutation, elevated fetal hemoglobin, and older age) were significantly enriched in the high methylation (HM) subgroup. A classifier was then developed that predicted subgroups with 98% accuracy across different technological platforms. Applying the classifier to an independent validation cohort confirmed an association of HM with secondary mutations, high relapse incidence, and inferior overall survival (OS), while the low methylation subgroup was associated with a favorable disease course. Multivariable analysis established DNA methylation subgroups as the only significant factor predicting OS.

Conclusions

This study provides an international consensus definition for DNA methylation subgroups in JMML. We developed and validated methods which will facilitate the design of risk-stratified clinical trials in JMML.

SUBMITTER: Schonung M 

PROVIDER: S-EPMC7785676 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

International Consensus Definition of DNA Methylation Subgroups in Juvenile Myelomonocytic Leukemia.

Schönung Maximilian M   Meyer Julia J   Nöllke Peter P   Olshen Adam B AB   Hartmann Mark M   Murakami Norihiro N   Wakamatsu Manabu M   Okuno Yusuke Y   Plass Christoph C   Loh Mignon L ML   Niemeyer Charlotte M CM   Muramatsu Hideki H   Flotho Christian C   Stieglitz Elliot E   Lipka Daniel B DB  

Clinical cancer research : an official journal of the American Association for Cancer Research 20201102 1


<h4>Purpose</h4>Known clinical and genetic markers have limitations in predicting disease course and outcome in juvenile myelomonocytic leukemia (JMML). DNA methylation patterns in JMML have correlated with outcome across multiple studies, suggesting it as a biomarker to improve patient stratification. However, standardized approaches to classify JMML on the basis of DNA methylation patterns are lacking. We, therefore, sought to define an international consensus for DNA methylation subgroups in  ...[more]

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