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Kinase signaling fuels growth of B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Yet its role in leukemia initiation is unclear and has not been shown in primary human hematopoietic cells. We previously described activating mutations in interleukin-7 receptor alpha (IL7RA) in poor-prognosis “ph-like” BCP-ALL. Here we show that expression of activated mutant IL7RA in human CD34 +  hematopoietic stem and progenitor cells induces a preleukemic state in transplanted immunodeficient NOD/LtSz- scid IL2Rγ   null   mice, characterized by persistence of self-renewing Pro-B cells with non-productive V(D)J gene rearrangements. Preleukemic CD34 + CD10 high CD19 +  cells evolve into BCP-ALL with spontaneously acquired Cyclin Dependent Kinase Inhibitor 2 A ( CDKN2A ) deletions, as commonly observed in primary human BCP-ALL. CRISPR mediated gene silencing of  CDKN2A  in primary human CD34 +  cells transduced with activated IL7RA results in robust development of BCP-ALLs in-vivo. Thus, we demonstrate that constitutive activation of IL7RA can initiate preleukemia in primary human hematopoietic progenitors and cooperates with CDKN2A silencing in progression into BCP-ALL.

An instructive role for Interleukin-7 receptor α in the development of human B-cell precursor leukemia