Overview
Mutations in the FOXO1 gene, which encodes a member of the forkhead family of transcription factors, play a significant role in diffuse large B-cell lymphoma (DLBCL). Mutations primarily occur in the first exon, with significant portions affecting the N-terminal region and the Forkhead DNA binding domain.1 These mutations are common in DLBCL, BL and, to a lesser extent, FL.2,3 FOXO1 mutations can contribute to resistance to certain therapies, such as anti-CD20-based immunotherapies, by repressing MS4A1 (CD20) expression.4
Experimental Evidence
Driver mutations affecting this gene in FL/DLBCL/BL have been experimentally demonstrated to cause a gain of function (GOF).1
Relevance tier by entity
| Entity | Tier | Description |
|---|---|---|
| 1 | High-confidence BL gene | |
| 1 | High-confidence DLBCL gene | |
| 1 | High-confidence FL gene | |
| 1 | High-confidence MZL gene | |
| 2 | Role of FOXO1 mutations in PMBL requires confirmation |
Mutation incidence in large patient cohorts (GAMBL reanalysis)
DLBCL
| Entity | Collection | N | mutated | Incidence | 95% CI |
|---|---|---|---|---|---|
| DLBCL | GAMBL without Reddy | 1,089 | 70 | 0.0643 | [0.0497,0.0788] |
| DLBCL | GAMBL with Reddy | 2,088 | 94 | 0.0450 | [0.0361,0.0539] |
| DLBCL | BC | 231 | 26 | 0.1126 | [0.0718,0.1533] |
| DLBCL | Dana-Farber | 303 | 5 | 0.0165 | [0.0022,0.0308] |
| DLBCL | NCI | 470 | 34 | 0.0723 | [0.0489,0.0958] |
| DLBCL | Reddy | 999 | 24 | 0.0240 | [0.0145,0.0335] |
| DLBCL | DLBCL_ICGC | 85 | 5 | 0.0588 | [0.0088,0.1088] |
FL
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BL
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Mutation pattern and selective pressure estimates
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FOXO1 Hotspots
| Chromosome | Coordinate (hg19) | ref>alt | HGVSp |
|---|---|---|---|
| chr13 | 41240294 | C>T | R19Q |
| chr13 | 41240294 | C>G | R19P |
| chr13 | 41240294 | C>A | R19L |
| chr13 | 41240289 | G>C | R21G |
| chr13 | 41240289 | G>A | R21C |
| chr13 | 41240288 | C>T | R21H |
| chr13 | 41240288 | C>G | R21P |
| chr13 | 41240288 | C>A | R21L |
| chr13 | 41240286 | AG>GC | S22P |
| chr13 | 41240286 | AG>GA | S22P |
| chr13 | 41240286 | A>G | S22P |
| chr13 | 41240285 | G>C | S22W |
| chr13 | 41240281 | G>T | C23* |
| chr13 | 41240280 | T>C | T24A |
| chr13 | 41240279 | G>A | T24I |
| chr13 | 41240277 | A>G | W25R |
| chr13 | 41240275 | C>T | W25* |
| chr13 | 41240274 | G>C | P26A |
| chr13 | 41240274 | G>A | P26S |
| chr13 | 41240273 | G>A | P26L |
| chr13 | 41240271 | G>C | L27V |
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