What is the frequency of PDGFRB mutations in sporadic solitary myofibroma and multifocal myofibromatosis, and what are the implications for clinical management?
In this international study of 69 patient samples, we identified activating PDGFRB mutations in children and infants but not adults, and the presence of mutations was strongly associated with multicentric disease. Most PDGFRB mutations were sensitive to the tyrosine kinase inhibitor imatinib, suggesting that they were attractive therapeutic targets.
The findings suggest that the presence of PDGFRB activating mutations provides a molecular diagnostic test and a basis for targeted therapy of infantile myofibromatosis.
Myofibroma is the most frequent fibrous tumor in children. Multicentric myofibroma (referred to as infantile myofibromatosis) is a life-threatening disease.
To determine the frequency, spectrum, and clinical implications of mutations in the PDGFRB receptor tyrosine kinase found in sporadic myofibroma and myofibromatosis.
Design, Setting, and Participants
In this retrospective study of 69 patients with sporadic myofibroma or myofibromatosis, 85 tumor samples were obtained and analyzed by targeted deep sequencing of PDGFRB. Mutations were confirmed by an alternative method of sequencing and were experimentally characterized to confirm gain of function and sensitivity to the tyrosine kinase inhibitor imatinib.
Main Outcomes and Measures
Frequency of gain-of-function PDGFRB mutations in sporadic myofibroma and myofibromatosis. Sensitivity to imatinib, as assessed experimentally.
Of the 69 patients with tumor samples (mean [SD] age, 7.8 [12.7] years), 60 were children (87%; 29 girls [48%]) and 9 were adults (13%; 4 women [44%]). Gain-of-function PDGFRB mutations were found in samples from 25 children, with no mutation found in samples from adults. Mutations were particularly associated with severe multicentric disease (13 of 19 myofibromatosis cases [68%]). Although patients had no familial history, 3 of 25 mutations (12%) were likely to be germline, suggesting de novo heritable alterations. All of the PDGFRB mutations were associated with ligand-independent receptor activation, and all but one were sensitive to imatinib at clinically relevant concentrations.
Conclusions and Relevance
Gain-of-function mutations of PDGFRB in myofibromas may affect only children and be more frequent in the multicentric form of disease, albeit present in solitary pediatric myofibromas. These alterations may be sensitive to tyrosine kinase inhibitors. The PDGFRB sequencing appears to have a high value for diagnosis, prognosis, and therapy of soft-tissue tumors in children.
Dachy G, de Krijger RR, Fraitag S, et al. Association of PDGFRB Mutations With Pediatric Myofibroma and Myofibromatosis. JAMA Dermatol. 2019;155(8):946–950. doi:10.1001/jamadermatol.2019.0114
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