Morbidity and mortality from ataxia-telangiectasia are associated with ATM genotype

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• 作者：Romain Micol MD ; MPH ; PhD^a ; ^b ; ^c ; ^* ; ^{romain.micol@gmail.com" rel="nofollow} ; Lilia Ben Slama PhD^a ; Felipe Suarez MD ; PhD^a ; ^d ; Loï ; c Le Mignot MSc^a ; ^e ; Julien Beauté ; MD ; MSc^a ; ^b ; Nizar Mahlaoui MD ; MSc^a ; ^b ; Catherine Dubois d’ ; Enghien BSc^f ; Anthony Laugé ; BSc^f ; Janet Hall PhD^g ; Jé ; rô ; me Couturier MD^f ; ^h ; Louis Vallé ; e MDⁱ ; Bruno Delobel MDⁱ ; Franç ; ois Rivier MD ; PhD^j ; Karine Nguyen MD^k ; Thierry Billette de Villemeur MD^l ; Jean-Louis Stephan MD^a ; ^m ; Pierre Bordigoni MD^a ; ⁿ ; Yves Bertrand MD^a ; ^o ; Nathalie Aladjidi MD^a ; ^p ; Jean-Michel Pedespan MD^q ; Caroline Thomas MD^a ; ^r ; Isabelle Pellier MD ; MSc^a ; ^s ; Michel Koenig MD ; PhD^t ; Olivier Hermine MD ; PhD^a ; ^d ; Capucine Picard MD ; PhD^a ; ^b ; ^w ; Despina Moshous MD ; PhD^b ; Bé ; né ; dicte Neven MD ; PhD^b ; Fanny Lanternier MD^u ; Sté ; phane Blanche MD^a ; ^b ; Marc Tardieu MD ; PhD^v ; Marianne Debré ; MD^a ; ^b ; Alain Fischer MD ; PhD^a ; ^b ; ^c ; ^w ; Dominique Stoppa-Lyonnet MD ; PhD^c ; ^f ; ^g ; CEREDIH Network
• 关键词：Cancer ; genetics ; leukemia ; lymphoma ; inherited ; DNA repair
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：128
• 期：2
• 页码：382-389.e1
• 全文大小：393 K

文摘

Background

Ataxia-telangiectasia (A-T) is a rare genetic disease caused by germline biallelic mutations in the ataxia-telangiectasia mutated gene (ATM) that result in partial or complete loss of ATM expression or activity. The course of the disease is characterized by neurologic manifestations, infections, and cancers.

Objective

We studied A-T progression and investigated whether manifestations were associated with the ATM genotype.

Methods

We performed a retrospective cohort study in France of 240 patients with A-T born from 1954 to 2005 and analyzed ATM mutations in 184 patients, along with neurologic manifestations, infections, and cancers.

Results

Among patients with A-T, the Kaplan-Meier 20-year survival rate was 53.4%; the prognosis for these patients has not changed since 1954. Life expectancy was lower among patients with mutations in ATM that caused total loss of expression or function of the gene product (null mutations) compared with that seen in patients with hypomorphic mutations because of earlier onset of cancer (mainly hematologic malignancies). Cancer (hazard ratio, 2.7; 95% CI, 1.6-4.5) and respiratory tract infections (hazard ratio, 2.3; 95% CI, 1.4-3.8) were independently associated with mortality. Cancer (hazard ratio, 5.8; 95% CI, 2.9-11.6) was a major risk factor for mortality among patients with null mutations, whereas respiratory tract infections (hazard ratio, 4.1; 95% CI, 1.8-9.1) were the leading cause of death among patients with hypomorphic mutations.

Conclusion

Morbidity and mortality among patients with A-T are associated with ATM genotype. This information could improve our prognostic ability and lead to adapted therapeutic strategies.