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Philadelphia-like B-cell precursor acute lymphoblastic leukemia (Ph-like ALL) is characterized by distinct genetic alterations and inferior prognosis in children and younger adults. The purpose of this study was a genetic and clinical characterization of Ph-like ALL in adults. Twenty-six (13%) of 207 adult patients (median age: 42 years) with B-cell precursor ALL (BCP-ALL) were classified as having Ph-like ALL using gene expression profiling. The frequency of Ph-like ALL was 27% among 95 BCP-ALL patients negative for BCR-ABL1 and KMT2A-rearrangements. IGH-CRLF2 rearrangements (6/16; P=0.002) and mutations in JAK2 (7/16; P<0.001) were found exclusively in the Ph-like ALL subgroup. Clinical and outcome analyses were restricted to patients treated in German Multicenter Study Group for Adult ALL (GMALL) trials 06/99 and 07/03 (n=107). The complete remission rate was 100% among both Ph-like ALL patients (n=19) and the “remaining BCP-ALL” cases (n=40), i.e. patients negative for BCR-ABL1 and KMT2A-rearrangements and the Ph-like subtype. Significantly fewer Ph-like ALL patients reached molecular complete remission (33% versus 79%; P=0.02) and had a lower probability of continuous complete remission (26% versus 60%; P=0.03) and overall survival (22% versus 64%; P=0.006) at 5 years compared to the remaining BCP-ALL patients. The profile of genetic lesions in adults with Ph-like ALL, including older adults, resembles that of pediatric Ph-like ALL and differs from the profile in the remaining BCP-ALL. Our study is the first to demonstrate that Ph-like ALL is associated with inferior outcomes in intensively treated older adult patients. Ph-like adult ALL should be recognized as a distinct, high-risk entity and further research on improved diagnostic and therapeutic approaches is needed.
Sensory processing relies on interactions between excitatory and inhibitory neurons, which are often coordinated by 30-80Hz gamma oscillations. However, the specific contributions of distinct interneurons to gamma synchronization remain unclear. We performed high-density recordings from V1 in awake mice and used optogenetics to identify PV+ (Parvalbumin) and Sst+ (Somatostatin) interneurons. PV interneurons were highly phase-locked to visually-induced gamma oscillations. Sst cells were heterogeneous, with only a subset of narrow-waveform cells showing strong gamma phase-locking. Interestingly, PV interneurons consistently fired at an earlier phase in the gamma cycle (≈6ms or 60 degrees) than Sst interneurons. Consequently, PV and Sst activity showed differential temporal relations with excitatory cells. In particular, the 1st and 2nd spikes in burst events, which were strongly gamma phase-locked, shortly preceded PV and Sst activity, respectively. These findings indicate a primary role of PV interneurons in synchronizing excitatory cells and suggest that PV and Sst interneurons control the excitability of somatic and dendritic neural compartments with precise time delays coordinated by gamma oscillations.