Aggressive Langerhans cell histiocytosis following T-ALL: Clonally related neoplasms with persistent expression of constitutively active NOTCH1

Scott J. Rodig, Ethan G. Payne, Barbara A. Degar, Barrett Rollins, Andrew L. Feldman, Elaine S. Jaffe, Arlene Androkites, Lewis B. Silverman, Janina A. Longtine, Jeffery L. Kutok, Mark D. Fleming, Jon C. Aster

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Abstract

Langerhans cell histiocytosis (LCH) and related entities are neoplasms of unknown pathogenesis. Here, we describe studies assessing the role of NOTCH1 mutations in LCH, which were based on a case of fatal Langerhans cell tumor after T-cell acute lymphoblastic leukemia (T-ALL). Although the two types of neoplasm in this patient were temporally and pathologically distinct, molecular analyses showed that they harbored the same T-cell receptor gene rearrangements and two activating NOTCH1 mutations involving exons 27 and 34. The exon 27 mutation altered a conserved cysteine residue in the N-terminal portion of the NOTCH1 heterodimerization domain, while the mutation in exon 34 introduced a premature stop codon that results in the deletion of C-terminal negative regulatory PEST domain. Analysis of cDNA prepared from the aggressive Langerhans cell tumor showed that the NOTCH1 mutations were aligned in cis, a configuration that caused synergistic increases in NOTCH1 signal strength in reporter gene assays. Immunohistochemistry confirmed that the Langerhans cell tumor also expressed NOTCH1 protein. Although these data suggested that NOTCH1 mutations might contribute to the pathogenesis of typical sporadic LCH and related neoplasms occurring in the absence of T-ALL, an analysis of 24 cases of LCH and Rosai-Dorfman Disease occurring in patients without an antecedent history of T-ALL revealed no mutations. Thus, activating NOTCH1 mutations appear to be unique to aggressive Langerhans cell tumors occurring after T-ALL. Persistent expression of NOTCH1 in such tumors suggests that Notch pathway inhibitors could have a role in the treatment of these unusual neoplasms.

Original languageEnglish (US)
Pages (from-to)116-121
Number of pages6
JournalAmerican journal of hematology
Volume83
Issue number2
DOIs
StatePublished - Feb 1 2008

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ASJC Scopus subject areas

  • Hematology

Cite this

Rodig, S. J., Payne, E. G., Degar, B. A., Rollins, B., Feldman, A. L., Jaffe, E. S., Androkites, A., Silverman, L. B., Longtine, J. A., Kutok, J. L., Fleming, M. D., & Aster, J. C. (2008). Aggressive Langerhans cell histiocytosis following T-ALL: Clonally related neoplasms with persistent expression of constitutively active NOTCH1. American journal of hematology, 83(2), 116-121. https://doi.org/10.1002/ajh.21044