A new sUSPect in T-ALL risk stratification

In this issue of Blood Advances, Illarregi et al 1 identify USP7 single-nucleotide variants (SNVs) as a potential prognostic marker for patients with T-cell acute lymphoblastic leukemia (T-ALL) at high risk of relapse.This retrospective, single-center study included 9 pediatric patients with newly diagnosed T-ALL, aged 4 to 14 years, who were treated under the SEHOP-PETHEMA 2013 protocol.Using RNA sequencing, it was determined that 3 of 9 patients had alterations in the USP7 gene, 2 of whom had an event during follow-up as compared with 1 of 6 patients without USP7 alterations.The authors also evaluated recently published genomic data from the Children's Oncology Group (COG) AALL0434 trial and found that patients aged <15 years with USP7 SNVs had statistically significant inferior eventfree survival (EFS) and disease-free survival (DFS) (5-year EFS: 73.5% vs 82.9%; P = .045and 5-year DFS: 71% vs 84.9%; P = .007).In multivariate analysis that included traditional prognostic variables for T-ALL, such as end-of-induction measurable residual disease (EOI MRD) and central nervous system (CNS) status, USP7 SNVs retained prognostic significance as an independent predictor of inferior EFS/DFS.