Utility of clinical comprehensive genomic characterization for diagnostic categorization in patients presenting with hypocellular bone marrow failure syndromes

Blombery, P; Fox, LC; Ryland, GL; Thompson, ER; Lickiss, J; McBean, M; Yerneni, S; Hughes, D; Greenway, A; Mechinaud, F; Wood, EM; Lieschke, GJ; Szer, J; Barbaro, P; Roy, J; Wight, J; Lynch, E; Martyn, M; Gaff, C; Ritchie, D

Author(s): Blombery, P; Fox, LC; Ryland, GL; Thompson, ER; Lickiss, J; McBean, M; Yerneni, S; Hughes, D; Greenway, A; Mechinaud, F; Wood, EM; Lieschke, GJ; Szer, J; Barbaro, P; Roy, J; Wight, J; Lynch, E; Martyn, M; Gaff, C; Ritchie, D;
Details: Publication Year 2021-01-01,Volume 106,Issue #1,Page 64-73
Journal Title: Haematologica
Publication Type: Research article
Abstract: Bone marrow failure (BMF) related to hypoplasia of hematopoietic elements in the bone marrow is a heterogeneous clinical entity with a broad differential diagnosis including both inherited and acquired causes. Accurate diagnostic categorization is critical to optimal patient care and detection of genomic variants in these patients may provide this important diagnostic and prognostic information. We performed real-time, accredited (ISO15189) comprehensive genomic characterization including targeted sequencing and whole exome sequencing in 115 patients with BMF syndrome (median age 24 years, range 3 months - 81 years). In patients with clinical diagnoses of inherited BMF syndromes, acquired BMF syndromes or clinically unclassifiable BMF we detected variants in 52% (12/23), 53% (25/47) and 56% (25/45) respectively. Genomic characterization resulted in a change of diagnosis in 30/115 (26%) including the identification of germline causes for 3/47 and 16/45 cases with pre-test diagnoses of acquired and clinically unclassifiable BMF respectively. The observed clinical impact of accurate diagnostic categorization included choice to perform allogeneic stem cell transplantation, disease-specific targeted treatments, identification of at-risk family members and influence of sibling allogeneic stem cell donor choice. Multiple novel pathogenic variants and copy number changes were identified in our cohort including in TERT, FANCA, RPS7 and SAMD9. Whole exome sequence analysis facilitated the identification of variants in two genes not typically associated with a primary clinical manifestation of BMF but also demonstrated reduced sensitivity for detecting low level acquired variants. In conclusion, genomic characterization can improve diagnostic categorization of patients presenting with hypoplastic BMF syndromes and should be routinely performed in this group of patients.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Bone Marrow Failure Disorders/diagnosis/genetics; Child; Child, Preschool; Genomics; Hematopoietic Stem Cell Transplantation; Humans; Infant; Middle Aged; Young Adult
Department(s): Haematology; Pathology
PubMed ID: 32054657
Publisher's Version: https://doi.org/10.3324/haematol.2019.237693
Open Access at Publisher's Site: https://doi.org/10.3324/haematol.2019.237693
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-06-13 06:48:00

Last Modified: 2025-06-13 06:48:45