Characteristics of Waldenström Macroglobulinemia in Korean Patients According to Mutational Status of MYD88 and CXCR4: Analysis Using Ultra-Deep Sequencing

Dong Woo Shin, Sung Min Kim, Jung Ah Kim, Hee Sue Park, Sang Mee Hwang, Kyongok Im, Sungsik Kim, Jinhyun Kim, Sunghoon Kwon, Sung Soo Yoon, Dong Soon Lee

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Background: Little is known about the mutational frequency of myeloid differentiation factor 88 (MYD88) and C-X-C chemokine receptor type 4 (CXCR4) and the corresponding characteristics in Asian individuals afflicted with Waldenström macroglobulinemia (WM). We investigated the characteristics of WM according to mutational status of MYD88/CXCR4, and attempted to determine the lineage commitment among hematopoietic cells by MYD88L265P single-cell sequencing on bone marrow (BM) smear slides. Materials and Methods: CXCR4 mutations (muts) were detected using ultra-deep sequencing using target capture. Mutational burden of MYD88 was assessed using real-time polymerase chain reaction. Single-cell sequencing for MYD88 was performed on lymphocytes, plasmacytoid lymphocytes, plasma cells, and neutrophils using laser microdissection. Results: Among 31 patients, the frequencies of MYD88/CXCR4 muts were as follows: MYD88 wild type (WT) CXCR4WT (6 patients, 19.4%), MYD88L265PCXCR4WT (19 patients, 61.4%), MYD88L265PCXCR4mut (6 patients, 19.4%; 1 frameshift and 5 nonsense muts). Immunoglobulin M levels of MYD88L265CXCR4WT patients were significantly higher than those of MYD88WTCXCR4WT patients (P = .024). Tumor burden in BM was highest in patients with MYD88L265PCXCR4mut (82.0%), followed by MYD88L265PCXCR4WT (52.8%) and MYD88WTCXCR4WT (14.2%) (P < .001). The quantity of MYD88-mutated DNA tended to correlate with tumor burden in BM (correlation coefficient 0.647; P = .009). MYD88L265P was detected in plasma cells, plasmacytoid lymphocytes, and lymphocytes but not neutrophils. Conclusion: The frequency of MYD88/CXCR4 muts in Korean and Caucasian patients with WM was similar, however 5 of the 6 CXCR4 muts were nonsense—a proportion higher than reported frequencies in Caucasian individuals. Ultra-deep sequencing was capable of detecting CXCR4 muts not detectable using Sanger sequencing, suggesting a possible replacement of the B-cell sorting. The frequencies of myeloid differentiation factor 88 (MYD88)/C-X-C chemokine receptor type 4 (CXCR4) mutations and the corresponding clinical characteristics in 31 Korean patients with Waldenström macroglobulinemia were assessed. Ultra-deep sequencing (for CXCR4) and several polymerase chain reaction-based methods (for MYD88) revealed that the frequencies of MYD88/CXCR4 mutations in these Korean patients were similar to reported frequencies for Caucasian individuals. Immunoglobulin M levels and tumor burden were highest in MYD88L265PCXCR4-mutation patients.

Original languageEnglish
Pages (from-to)e496-e505
JournalClinical Lymphoma, Myeloma and Leukemia
Issue number8
StatePublished - Aug 2019


  • CXCR4
  • MYD88
  • Single cell analysis
  • Ultra-deep sequencing
  • Waldenström macroglobulinemia

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