Self-controlled Sequencing Suggests that Somatic Mutations of Signaling, Transcription and Tumor Suppression Genes are a Precondition for AML Transformation in MDS

Abstract Background The transformation biology of secondary AML from MDS is still not fully understood. Here, we performed a large cohort of paired self-controlled sequences including target, whole-exome and single cell sequencing to search AML transformation-related mutations (TRMs). Methods 39 target genes from paired samples from 72 patients with MDS who had undergone AML transformation were analyzed by next generation target sequencing. Whole exome and single-cell RNA sequencing were used to verify the dynamics of transformation. Results The target sequencing results showed that sixty-four out of the 72 (88.9%) patients presented presumptive TRMs involving activated signaling, transcription factors, or tumor suppressors. Of the 64 patients, most of TRMs (62.5%, 40 cases) emerged at the leukemia transformation point. All three of the remaining eight patients analyzed by paired whole exome sequencing showed TRMs which are not included in the reference targets. No patient with MDS developed into AML only by acquiring mutations involved in epigenetic modulation or RNA splicing. Single-cell sequencing in one pair sample indicated that the activated cell signaling route was related to TRMs which take place prior to phenotypic development. Of note, target sequencing defined TRMs were limited to a small set of seven genes (in the order: NRAS/KRAS, CEBPA, TP53, FLT3, CBL, PTPN11 and RUNX1, accounted for nearly 90.0% of the TRMs). Conclusions Somatic mutations involving in signaling, transcription factors, or tumor suppressors appeared to be a precondition for AML transformation from MDS. The TRMs may be considered as new therapy targets.