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Abstract
Infant gliomas have paradoxical clinical behavior compared to those in children and adults: low-grade tumors have a higher mortality rate, while high-grade tumors have a better outcome. However, we have little understanding of their biology and therefore cannot explain this behavior nor what constitutes optimal clinical management. Here we report a comprehensive genetic analysis of an international cohort of clinically annotated infant gliomas, revealing 3 clinical subgroups. Group 1 tumors arise in the cerebral hemispheres and harbor alterations in the receptor tyrosine kinases ALK, ROS1, NTRK and MET. These are typically single-events and confer an intermediate outcome. Groups 2 and 3 gliomas harbor RAS/MAPK pathway mutations and arise in the hemispheres and midline, respectively. Group 2 tumors have excellent long-term survival, while group 3 tumors progress rapidly and do not respond well to chemoradiation. We conclude that infant gliomas comprise 3 subgroups, justifying the need for specialized therapeutic strategies.
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1 Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Oncology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
2 Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
3 The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
4 The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
5 Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
6 Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
7 Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
8 Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
9 Division of Anatomic Pathology, British Columbia Children’s Hospital, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
10 Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada; Division of Hematology/Oncology/BMT, British Columbia Children’s Hospital, Vancouver, BC, Canada
11 Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA
12 Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children’s Hospital, Columbus, OH, USA
13 Department of Pathology, Hospital Universitario Niño Jesús, Madrid, Spain
14 Department of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
15 Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
16 Department of Oncology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
17 Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
18 Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
19 Department of Pediatric Oncology, Hospital Cruces, Bilbao, Spain
20 Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
21 Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
22 Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
23 Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
24 Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
25 Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan
26 Division of Pediatric Hematoncology, University Hospital de São João, Porto, Portugal
27 Department of Pathology, University Hospital de São João, Porto, Portugal
28 Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
29 Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
30 Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
31 Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada
32 Department of Anatomic Pathology, Dalhousie University, Halifax, NS, Canada; Department of Pathology Laboratory Medicine, IWK Health Centre, Halifax, NS, Canada
33 Division of Neurosurgery, IWK Health Centre, Halifax, NS, Canada
34 Division of Hematology-Oncology, IWK Health Centre, Halifax, NS, Canada
35 The Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem, Israel
36 Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, Australia
37 Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, Australia; Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
38 Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN, USA
39 Department of Medicine, McGill University, Montreal, QC, Canada
40 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
41 Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
42 Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
43 Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
44 Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada