Mutant nucleophosmin and cooperating pathways drive leukemia initiation and progression in mice

Acute myeloid leukemia (AML) is a molecularly diverse malignancy with a poor prognosis, whose largest subgroup is characterized by somatic mutations in NPM1, the gene for Nucleophosmin1. These mutations, termed NPM1c, result in cytoplasmic dislocation of Nucleophosmin1 and are associated with distinctive transcriptional signatures2, yet their role in leukemogenesis remains obscure. Here we report that activation of a humanized Npm1c knock-in allele in murine hemopoietic stem cells causes Hox overexpression, enhanced self-renewal and expanded myelopoiesis. One third of mice developed delayed-onset AML, suggesting a requirement for cooperating mutations. We identified such mutations using a Sleeping Beauty3-4 transposon which caused rapid-onset AML in 80% of Npm1c+ mice, associated with mutually exclusive integrations in Csf2, Flt3 or Rasgrp1 in 55 of 70 leukemias. Recurrent integrations were also identified in known and novel leukemia genes including Nf1, Bach2, Dleu2 and Nup98. Our results give new pathogenetic insights and identify therapeutic targets in NPM1c+ AML.