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Supplementary Figure 3 from Validation of Guidelines for Genetic Investigation of Myeloid Neoplasms with Germline Predisposition: Results from a Prospective Cohort Study

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posted on 2025-07-15, 07:23 authored by Bianca Tesi, Anna Robelius, Berivan Baskin, Vladimir Lazarevic, Stefan Deneberg, Martin Höglund, Linda Fogelstrand, Johanna Ungerstedt, Tatjana Pandzic, Magnus Tobiasson, Hege Gravdahl Garelius, Ekaterina Kuchinskaya, Fredrik Persson, Helena Ågerstam, Helene Hallböök, Thoas Fioretos, Jessika Nordin, Anna Norberg, Ann-Charlotte Thuresson, Sören Lehmann, Claes Ladenvall, Gisela Barbany, Lovisa Vennström, Elisabeth Ejerblad, Lucia Cavelier, Jörg Cammenga, Martin Jädersten, Eva Hellström-Lindberg, Panagiotis Baliakas
<p>Supplementary Figure 3. Pedigrees and Relative telomere length (TL) in two patients with a missense VUS in TERT measured by qPCR in peripheral blood leukocytes as previously described.1 The reference percentiles were determined from telomere length analysis of blood leukocytes from 283 healthy subjects (0–78 years of age). The curves shown depict the first, 10th, 50th, 90th, and 99th normal percentiles at each age, where the 50th percentile represents the mean. A) Patient GH01_P11 was included due to cytopenias, premature graying of hair, infections, skin hypomelanosis. The variant segregated in the mother, who did not show clinical signs of telomere biology disorders but displayed shorter TL. B) Patient GH01_P33 was included due to MDS, lung fibrosis, premature graying of hair. The family history was positive for lung fibrosis on paternal side and for leukemia and premature graying of hair on the maternal side. Segregation analysis in parental samples was not possible. Reference: 1. Norberg A, Rosén A, Raaschou-Jensen K, et al: Novel variants in Nordic patients referred for genetic testing of telomere-related disorders. Eur J Hum Genet 26:858–867, 2018</p>

Funding

Swedish Cancer Foundation

Barncancerfonden (Swedish Childhood Cancer Foundation)

Center for Innovative Medicine (CIMED)

Vleugels Stiftelse

Stockholm läns landsting (Stockholm County Council)

Region Uppsala

Svenska Läkaresällskapet (SLS)

Cancerfonden (Swedish Cancer Society)

History

ARTICLE ABSTRACT

In a multicenter prospective cohort study, we assessed the diagnostic yield of the Nordic guidelines for germline investigation in myeloid neoplasms and mapped the spectrum of inherited and somatic variants. Eighty-five patients (acute myeloid leukemia, n = 38; myelodysplastic syndromes, n = 26; thrombocytopenia, n = 14; and other, n = 7) fulfilling the Nordic criteria for germline investigation, based on (i) medical history or family history suggestive of a germline condition and (ii) relevant findings from the somatic diagnostic work-up (CytoMol), were recruited. The genetic analysis included enhanced whole-exome sequencing (n = 69) or sequencing of specific variants of interest (n = 16). Pathogenic or likely pathogenic (P/LP) germline variants were identified in 35% of patients (30/85). The diagnostic yield varied from 6% (1/16) in the family history group to 52% (17/33) in the CytoMol group. Germline DDX41 P/LP variants were the most frequent finding (13/30, 43% of all positive cases) almost exclusively found within the CytoMol group (12/13). Seven variants of unknown significance were also detected (TERT n = 2 and DDX41, RTEL1, ETV6, PARN, and SAMD9 n = 1). Five patients carried a P/LP variant in genes associated with another hereditary cancer syndrome (BRCA1 n = 3; PALB2 n = 1; and CHEK2; n = 1). Survival analysis showed a trend for longer survival among patients with acute myeloid leukemia and confirmed or suspected germline predisposition that underwent allogeneic stem cell transplantation. The implementation of the Nordic guidelines in a prospective Swedish cohort results in a high overall diagnostic yield (35%), proving the feasibility and utility of these or similar guidelines in a clinical setting.