Abstract
Abstract BACKGROUND High-grade gliomas (HGG) in young children pose a challenge due to favorable but unpredictable outcomes. While retrospective studies have broadened our understanding of tumor biology, prospective data regarding outcomes and molecular predictors is lacking. METHODS Young children (0-5 years) histologically diagnosed with HGG and enrolled on the SJYC07 trial or treated at St Jude Children’s Research Hospital from November 2007 to December 2020 were included. DNA methylation, whole genome (WGS), whole exome (WES), and RNA (RNA-seq) sequencing were performed on available samples and these data were integrated with standard histopathological tests to yield a diagnosis. Clinical characteristics and pre-operative imaging were analyzed. RESULTS Fifty-six children (0.0-4.4 years) were identified. Integrated molecular and histopathological analysis split the tumors into four categories: infant-type hemispheric glioma (IHG), HGG, low-grade glioma (LGG), and other-central nervous system (CNS) tumors (i.e., CNS embryonal tumors, CNS sarcomas, neuroepithelial tumors). IHG was the most prevalent (N=22), occurred in the youngest patients (median age 0.4 years; 0-4.4 years), and commonly harbored receptor tyrosine kinase gene fusions (7 ALK, 2 ROS1, 3 NTRK1/2/3, 4 MET). The 5-year event-free (EFS) and overall survival (OS) for IHG was 53.13% (95% CI: 35.52 -79.47) and 90.91% (95%CI: 79.66-100.00) vs. 0.0% and 16.67% (95% CI: 2.78-99.74%) for HGG (p= 0.0043, 0.00013). EFS and OS were not different between IHG and LGG (p=0.95, 0.43). Imaging review of HGG, LGG , IHG and Other CNS tumors showed that IHGs are associated with circumscribed margins (p=0.0047), hemispheric location (p=0.0010), and hemorrhage (p=0.0149). CONCLUSIONS HGG in young children is not a single-entity and is best defined by an integrated histopathological and molecular diagnosis. While patients with IHGs display good survival, as compared to other pediatric HGGs, they still suffer severe treatment-related morbidities. Therefore, prompt consideration for reduced adjuvant and molecularly targeted therapies is warranted.
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