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PLoS Comput Biol. 2019 Jan 7;15(1):e1006664. doi: 10.1371/journal.pcbi.1006664. [Epub ahead of print]

Mutation, drift and selection in single-driver hematologic malignancy: Example of secondary myelodysplastic syndrome following treatment of inherited neutropenia.

Author information

1
Systems Engineering Group, Silesian University of Technology, Gliwice, Poland.
2
Department of Pediatrics, Cleveland Clinic, Cleveland, OH, United States of America.
3
Department of Cancer Biology, Cleveland Clinic, Cleveland, OH, United States of America.
4
Clinical Pediatrics, Division of Hospital Medicine, Stony Brook Children's Hospital, Stony Brook, New York.
5
Department of Statistics, Rice University, Houston, TX, United States of America.
6
Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Chicago, IL United States of America.
7
Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL United States of America.
8
Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, United States of America.
9
Department of Bioengineering, Rice University, Houston, TX, United States of America.

Abstract

Cancer development is driven by series of events involving mutations, which may become fixed in a tumor via genetic drift and selection. This process usually includes a limited number of driver (advantageous) mutations and a greater number of passenger (neutral or mildly deleterious) mutations. We focus on a real-world leukemia model evolving on the background of a germline mutation. Severe congenital neutropenia (SCN) evolves to secondary myelodysplastic syndrome (sMDS) and/or secondary acute myeloid leukemia (sAML) in 30-40%. The majority of SCN cases are due to a germline ELANE mutation. Acquired mutations in CSF3R occur in >70% sMDS/sAML associated with SCN. Hypotheses underlying our model are: an ELANE mutation causes SCN; CSF3R mutations occur spontaneously at a low rate; in fetal life, hematopoietic stem and progenitor cells expands quickly, resulting in a high probability of several tens to several hundreds of cells with CSF3R truncation mutations; therapeutic granulocyte colony-stimulating factor (G-CSF) administration early in life exerts a strong selective pressure, providing mutants with a growth advantage. Applying population genetics theory, we propose a novel two-phase model of disease development from SCN to sMDS. In Phase 1, hematopoietic tissues expand and produce tens to hundreds of stem cells with the CSF3R truncation mutation. Phase 2 occurs postnatally through adult stages with bone marrow production of granulocyte precursors and positive selection of mutants due to chronic G-CSF therapy to reverse the severe neutropenia. We predict the existence of the pool of cells with the mutated truncated receptor before G-CSF treatment begins. The model does not require increase in mutation rate under G-CSF treatment and agrees with age distribution of sMDS onset and clinical sequencing data.

PMID:
30615612
DOI:
10.1371/journal.pcbi.1006664
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Conflict of interest statement

The authors have declared that no competing interests exist.

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