Immature Immunoglobulin Gene Rearrangements Are Recurrent In B Precursor Adult Acute Lymphoblastic Leukemia Carryingtp53molecular Alterations

Here, we describe the immunoglobulin and T cell receptor (Ig/TCR) molecular rearrangements identified as a leukemic clone hallmark for minimal residual disease assessment in relation toTP53mutational status in 171 Ph-negative Acute Lymphoblastic Leukemia (ALL) adult patients at diagnosis. The presence of aTP53alterations, which represents a marker of poor prognosis, was strictly correlated with an immature DH/JH rearrangement of the immunoglobulin receptor (p< 0.0001). Furthermore,TP53-mutated patients were classified as pro-B ALL more frequently than their wild-type counterpart (46% vs. 25%,p= 0.05). Although the reasons for the co-presence of immature Ig rearrangements andTP53mutation need to be clarified, this can suggest that the alteration inTP53is acquired at an early stage of B-cell maturation or even at the level of pre-leukemic transformation.