(7/7) Identifying NOTCH1 mutations or intragenic deletions is important for diagnostic and prognostic purposes. As the key driver of leukemogenesis in T-ALL, NOTCH1 mutations can clinch the diagnosis. While NOTCH1 mutations may not define prognosis, they can serve as a molecular marker for minimal residual disease (MRD) in selected patients. Emerging therapies like ฮณ-Secretase inhibitors (GSIs) and combination therapies with glucocorticoids, mTOR inhibitors, or BCL2 inhibitors, BET inhibitors and CDK7 inhibitors are currently being tested; there are no FDA-approved targeted therapies for NOTCH1 in T-ALL.
On a personal note, we had a patient with suspected T-ALL who had a negative NOTCH1 variant in our hybrid capture-based targeted Next Generation Sequencing (NGS) assay, but we were able to detect an intragenic NOTCH1 deletion between intron 2 and exon 28 in an amplicon-based NGS assay dedicated to identifying fusion partners, highlighting the utility of various NGS panel based assays in molecular and precision diagnostics as well.
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