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Acute lymphoblastic leukemia (ALL) is the most successful paradigm of how risk-adapted therapy and detailed understanding of the genetic alterations driving leukemogenesis and therapeutic response may dramatically improve treatment outcomes, with cure rates now exceeding 90% in children.
Platform |
Capability |
Cost |
Detectable Subtypes |
Difficult Subtypes |
---|---|---|---|---|
WTS (RNAseq) |
Fusion chimeras Gene expression profiling Mutant allele expression Alternative splicing analysis (BCR/TCR rearrangements) (Sequence mutations) (Copy number analysis) |
Moderate |
B-ALL ETV6-RUNX1; KMT2A; TCF3-PBX1; BCR-ABL1; DUX4; MEF2D; ZNF384/362 NUTM1; HLF; BCL2/MYC; PAX5alt; ZEB2/CEBPE; -like subtypes |
B-ALL Aneuploidies |
T-ALL HOXA (KMT2A-R, PICALM-MLLT10, SET-NUP214); SPI1; NKX2-1; TAL1 (STIL-TAL1) |
T-ALL BCL11B; TLX1/3; LMO1/2; HOXA (others); TAL1 (others); T-other |
|||
WGS |
Sequence mutations Structural variants Copy number analysis (BCR/TCR rearrangements) (GWAS) |
High |
B-ALL Aneuploidies; ETV6-RUNX1; KMT2A; TCF3-PBX1; BCR-ABL1; DUX4; MEF2D; ZNF384/362; NUTM1; HLF; BCL2/MYC; PAX5 P80R; IKZF1 N159Y; ZEB2/CEBPE; Sequence and structural alterations in Ph-like ALL |
B-ALL -like subtypes; Part of PAX5alt |
T-ALL BCL11B; TLX1/3; LMO1/2; HOXA; SPI1; NKX2-1; TAL1 |
T-ALL T-other |
|||
WES |
Sequence mutations (coding) Structural variants (coding) Copy number analysis |
Moderate |
B-ALL (Aneuploidies) PAX5 P80R IKZF1 N159Y Sequence mutations in Ph-like ALL (e.g., JAK1/2/3, Ras) |
Most of other B-ALL and T-ALL subtypes |
Targeted sequencing (DNA and/or RNA) |
Fusion chimeras (targeted) Gene expression (targeted) Sequence mutations (targeted) Structural variants (targeted) (Copy number analysis) |
Low |
Targeted alterations |
Non-targeted alterations |
The parenthesis in “Capability” indicates analyses in development. Abbreviations: WTS: whole transcriptome sequencing; BCR: B-cell receptor; TCR: T-cell receptor; WGS: whole genome sequencing; GWAS: genome wide association study; WES: whole exome sequencing; -R: rearranged.