Genetic and Epigenetic Features of Rapidly Progressing IDH-Mutant Astrocytomas.

Gaoxiang Jia, MS
Gaoxiang Jia, MS
Southern Methodist University
Graduate Student
Dallas, Texas | US
Adwait Sathe, PhD
Adwait Sathe, PhD
The University of Texas at Southwestern Medical Center
Computational Biologist
Dallas, Texas | United States
Adwait Amod Sathe, PhD
Adwait Amod Sathe, PhD
UT Southwestern Medical Center
Computational Biologist
Dallas, TX | United States

J Neuropathol Exp Neurol 2018 07;77(7):542-548

Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.

IDH-mutant astrocytomas are significantly less aggressive than their IDH-wildtype counterparts. We analyzed The Cancer Genome Atlas dataset (TCGA) and identified a small group of IDH-mutant, WHO grade II-III astrocytomas (n = 14) with an unexpectedly poor prognosis characterized by a rapid progression to glioblastoma and death within 3 years of the initial diagnosis. Compared with IDH-mutant tumors with the typical, extended progression-free survival in a control group of age-similar patients, the tumors in the rapidly progressing group were characterized by a markedly increased level of overall copy number alterations ([CNA]; p = 0.006). In contrast, the mutation load was similar, as was the methylation pattern, being consistent with IDH-mutant astrocytoma. Two of the gliomas (14%) in the rapidly progressing, IDH-mutant group but none of the other grade II-III gliomas in the TCGA (n = 283) had pathogenic mutations in genes (FANCB and APC) associated with maintaining chromosomal stability. These results suggest that chromosomal instability can negate the beneficial effect of IDH mutations in WHO II-III astrocytomas. The mechanism of the increased CNA is unknown but in some cases appears to be due to mutations in genes with a role in chromosomal stability. Increased CNA could serve as a biomarker for tumors at risk for rapid progression.

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