66a92f8715410aad17eec09603dbf306 pmc_32635531.pdf 887c19ae2b4de70997f270bdb5eb24b9fea7a4f7 pmc_32635531.pdf 9b862ef444abf3f205b90e36af703e00478136a33644a75d75279dd0996b3c36 pmc_32635531.pdf Title: Integrated Genomic Analysis of Chromosomal Alterations and Mutations in B-Cell Acute Lymphoblastic Leukemia Reveals Distinct Genetic Profiles at Relapse Subject: The clonal basis of relapse in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is complex and not fully understood. Next-generation sequencing (NGS), array comparative genomic hybridization (aCGH), and multiplex ligation-dependent probe amplification (MLPA) were carried out in matched diagnosis–relapse samples from 13 BCP-ALL patients to identify patterns of genetic evolution that could account for the phenotypic changes associated with disease relapse. The integrative genomic analysis of aCGH, MLPA and NGS revealed that 100% of the BCP-ALL patients showed at least one genetic alteration at diagnosis and relapse. In addition, there was a significant increase in the frequency of chromosomal lesions at the time of relapse (p = 0.019). MLPA and aCGH techniques showed that IKZF1 was the most frequently deleted gene. TP53 was the most frequently mutated gene at relapse. Two TP53 mutations were detected only at relapse, whereas the three others showed an increase in their mutational burden at relapse. Clonal evolution patterns were heterogeneous, involving the acquisition, loss and maintenance of lesions at relapse. Therefore, this study provides additional evidence that BCP-ALL is a genetically dynamic disease with distinct genetic profiles at diagnosis and relapse. Integrative NGS, aCGH and MLPA analysis enables better molecular characterization of the genetic profile in BCP-ALL patients during the evolution from diagnosis to relapse. Keywords: acute lymphoblastic leukemia (ALL); relapse; next-generation sequencing (NGS); array comparative genomic hybridization (aCGH); multiplex ligation-dependent probe amplification (MLPA); IKZF1; TP53 Author: Maribel Forero-Castro, Adrián Montaño, Cristina Robledo, Alfonso García de Coca, José Luis Fuster, Natalia de las Heras, José Antonio Queizán, María Hernández-Sánchez, Luis A. Corchete-Sánchez, Marta Martín-Izquierdo, Jordi Ribera, José-María Ribera, Rocío Benito and Jesús M. 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