- Kim, Jaeseung C;
- Chan-Seng-Yue, Michelle;
- Ge, Sabrina;
- Zeng, Andy GX;
- Ng, Karen;
- Gan, Olga I;
- Garcia-Prat, Laura;
- Flores-Figueroa, Eugenia;
- Woo, Tristan;
- Zhang, Amy Xin Wei;
- Arruda, Andrea;
- Chithambaram, Shivapriya;
- Dobson, Stephanie M;
- Khoo, Amanda;
- Khan, Shahbaz;
- Ibrahimova, Narmin;
- George, Ann;
- Tierens, Anne;
- Hitzler, Johann;
- Kislinger, Thomas;
- Dick, John E;
- McPherson, John D;
- Minden, Mark D;
- Notta, Faiyaz
In BCR-ABL1 lymphoblastic leukemia, treatment heterogeneity to tyrosine kinase inhibitors (TKIs), especially in the absence of kinase domain mutations in BCR-ABL1, is poorly understood. Through deep molecular profiling, we uncovered three transcriptomic subtypes of BCR-ABL1 lymphoblastic leukemia, each representing a maturation arrest at a stage of B-cell progenitor differentiation. An earlier arrest was associated with lineage promiscuity, treatment refractoriness and poor patient outcomes. A later arrest was associated with lineage fidelity, durable leukemia remissions and improved patient outcomes. Each maturation arrest was marked by specific genomic events that control different transition points in B-cell development. Interestingly, these events were absent in BCR-ABL1+ preleukemic stem cells isolated from patients regardless of subtype, which supports that transcriptomic phenotypes are determined downstream of the leukemia-initialing event. Overall, our data indicate that treatment response and TKI efficacy are unexpected outcomes of the differentiation stage at which this leukemia transforms.