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Abstract
Using next generation sequencing we have systematically analyzed a large cohort of 489 patients with bone marrow failure (BMF), including myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), aplastic anemia (AA), and related conditions for the presence of germline (GL) alterations in Fanconi Anemia (FA) and telomerase genes. We have detected an increased frequency of heterozygous FA gene mutations in MDS and to lesser degree in AML suggesting that the presence of one normal allele may not be completely protective and indeed heterozygous FA lesions may have a long latency period before hematologic manifestation. In contrast, GL telomerase gene mutations were not associated with increased disease risk. When compared to large control cohorts, we have not detected an increased frequency of damaging variants among telomerase complex genes, including those previously believed to be involved in the pathogenesis of AA. Our results may suggest that while low penetrance and delayed disease onset can confound identification of genetic predisposition factors, GL FA alterations can be also associated with MDS.
Highlights
Familial myelodysplastic syndrome (MDS) and aplastic anemia (AA) are rarely reported in adults and usually in the context of early-onset diseases
Using generation sequencing we have systematically analyzed a large cohort of 489 patients with bone marrow failure (BMF), including myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), aplastic anemia (AA), and related conditions for the presence of germline (GL) alterations in Fanconi Anemia (FA) and telomerase genes
We found 2 splicing variants (RAD51C and FANCA) and one stop gain variant (FANCC) (Figure 1, Supplementary Table 2)
Summary
Familial myelodysplastic syndrome (MDS) and aplastic anemia (AA) are rarely reported in adults and usually in the context of early-onset diseases. A patient’s family history may indicate inherited predisposition, but late onset, or incomplete penetrance often obscure assessment of hereditary factors and aging or environmental exposures are implicated more often than genetic factors in the pathogenesis of sporadic MDS. Fanconi Anemia (FA) is a prototypic inherited autosomal recessive bone marrow failure (BMF) syndrome with a highly variable penetrance [8]. Dyskerin mutations are associated in autosomal dominant fashion with another hereditary BMF syndrome, dyskeratosis congenita (DC) [14], but mutations of other members of the telomerase complex, TERT and TERC, have been implicated in predisposition to both AA and MDS [15,16,17,18]
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