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Cytogenetic and molecular risk groups were categorized according to European LeukemiaNet recommendations.
Spatial conservation of prognostically-relevant and therapeutically-targetable somatic mutations in DIPG and mHGG contrasts the significant heterogeneity of driver mutations seen in adult HGG and supports uniform implementation of diagnostic biopsy in DIPG and mHGG to classify molecular risk groups and guide therapeutic strategy.
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6 Even within each molecular risk group, older patients tend to have a more chemoresistant disease, the precise mechanisms for which are unknown.
In our discovery approach, we focused on intermediate molecular risk group patients (non-WNT, non-medulloblastoma with extensive nodularity (MBEN), non- MYC amplified) to develop a prognostic index, since this remains a relatively large population of patients that has proven difficult to further stratify in a clinical setting.
Poor-risk cytogenetics or molecular events, risk groups according to both NCI or PETHEMA classifications, good risk features (hyperdiploidy and TEL-AML1 fusion), type of PETHEMA protocol administered and number of patients who received stem cell transplantation were similarly distributed between the two groups defined by Dkk-3 methylation.
The authors apply data mining techniques such as hierarchical clustering to create molecular cluster and risk groups.
Nearly full-length genome sequences generated by this study provide reference material for high-throughput sequencing and for tracking the molecular epidemics in different risk groups and in Estonia and neighboring countries.
Clinically applicable risk models are developed to generate individualized molecular scores to identify distinctive risk groups.
Ongoing acquisition of pre-treatment tissue will allow refinement of histone mutation-based risk groups and molecular signatures, which have potential to elucidate oncogenic mechanisms and resistance pathways.
Table 2 showed the results of different cytogenetic and molecular risk stratification between the two groups of patients.
With continued improvements in diagnostic imaging modalities, definition of risk groups, discovery of molecular markers, and development of new therapeutic strategies, improved survival rates should result in the future.
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