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MLL(KMT2A) rearrangements are among the most frequent chromosomal abnormalities that occur in acute myeloid leukemia (AML). Mutational landscapes in KMT2A-rearranged AML have been reported; however, most studies are missing data at relapse. Therefore, matched diagnostic and relapse samples were analyzed in this study, and the clonal evolution pattern in KMT2A-rearranged AML was examined. Further, the prognostic significance of the clonal architecture was investigated.

Nannya: Otsuka Pharmaceutical Co., Ltd.: Consultancy, Speakers Bureau; Astellas: Speakers Bureau. Saito: Toshiba corporation: Research Funding. Ogawa: Kan Research Laboratory, Inc.: Consultancy, Research Funding; Otsuka Pharmaceutical Co., Ltd.: Research Funding; Dainippon-Sumitomo Pharmaceutical, Inc.: Research Funding; Eisai Co., Ltd.: Research Funding; Ashahi Genomics: Current holder of individual stocks in a privately-held company; ChordiaTherapeutics, Inc.: Consultancy, Research Funding.

Purpose: Osteonecrosis (ON) is a serious complication of the treatment of childhood acute lymphoblastic leukemia (ALL). The incidence of ON varies (range, 2.0-18.0%) according to treatment strategy. Previous studies reported older age, female sex, dosage of corticosteroid, use of dexamethasone (DEX), combination therapy with DEX and L-asparaginase (L-Asp), and ethnicity were putative risk factors. However, most of these studies were mainly conducted in U.S.A. or European countries. Thus, the data relating to ON in Asian ALL patients are scarce. Herein, we performed a retrospective analysis of Japanese ALL patient cohorts uniformly treated with consecutive two clinical trials (ALL-97 and ALL-02) to clarify the incidence, clinical characteristics and risk factors of ON.