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Approximately 18% of acute myeloid leukemia (AML) cases express a fusion transcript. However, few fusions are recurrent across AML and the identification of these rare chimeras is of interest to characterize AML patients. Here, we studied the transcriptome of 8 adult AML patients with poorly described chromosomal translocation(s), with the aim of identifying novel and rare fusion transcripts. We integrated RNA-sequencing data with multiple approaches including computational analysis, Sanger sequencing, fluorescence in situ hybridization and in vitro studies to assess the oncogenic potential of the  ZEB2-BCL11B  chimera. We detected 7 different fusions with partner genes involving transcription factors ( OAZ-MAFK ,  ZEB2-BCL11B ), tumor suppressors ( SAV1-GYPB ,  PUF60-TYW1 ,  CNOT2-WT1 ) and rearrangements associated with the loss of  NF1  ( CPD-PXT1 ,  UTP6-CRLF3 ). Notably,  ZEB2-BCL11B  rearrangements co-occurred with  FLT3  mutations and were associated with a poorly differentiated or mixed phenotype leukemia. Although the fusion alone did not transform murine c-Kit+ bone marrow cells, 45.4% of 14q32 non-rearranged AML cases were also BCL11B-positive, suggesting a more general and complex mechanism of leukemogenesis associated with BCL11B expression. Overall, by combining different approaches, we described rare fusion events contributing to the complexity of AML and we linked the expression of some chimeras to genomic alterations hitting known genes in AML.

Novel and Rare Fusion Transcripts Involving Transcription Factors and Tumor Suppressor Genes in Acute Myeloid Leukemia