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Early age acute leukemia (EAL) shows a high frequency of  KMT2A -rearrangements ( KMT2A -r). Previous investigations highlighted double-strand breaks arising from maternal exposure to xenobiotics during pregnancy as a risk factor for EAL and  KMT2A -r. In this case-control study, we investigated the relationship between EAL and genetic variants of the nonhomologous end-joining ( XRCC6  rs5751129,  XRCC4  rs6869366 and rs28360071), since they might affect DNA repair capacity, leading to  KMT2A -r and leukemogenesis. Samples from 577 individuals (acute lymphoblastic leukemia-ALL, n=164; acute myeloid leukemia-AML, n=113; controls, n=300) were genotyped. No significant association was found for rs5751129 and rs6869366, whereas rs28360071 was associated with an increased risk for ALL with  KMT2A-r  (IIxID: OR - Odds ratio 2.23, CI 1.17-4.25,  p =0.014). Bone marrow samples from ALL patients showed a higher expression of  XRCC4  compared to AML patients ( p =0.025).  Human Splicing Finder 3.1  predicted that the deleted allele of rs28360071 is potentially associated with the activation of a 5’ cryptic splice site in intron 3 of  XRCC4 . The sequencing of cDNA did not show any differences on the splicing process for the rs28360071 genotypes. Our results suggest that the deleted allele for rs28360071 increases the risk for ALL with  KMT2A-r , but not by modifying the  XRCC4  expression levels or its structure.

XRCC4 rs28360071 intronic variant is associated with increased risk for infant acute lymphoblastic leukemia with KMT2A rearrangements