Abstract
GATA2 deficiency syndrome (G2DS) is a rare autosomal dominant genetic
disease predisposing to a range of symptoms of which myeloid malignancy
and immunodeficiency including recurrent infections are most common. In
the last decade since it was first reported, there have been over 465
individuals identified carrying a pathogenic or likely pathogenic
germline GATA2 variant with symptoms of G2DS, with 231 of these
confirmed to be familial and 22 de novo. For those that develop myeloid
malignancy (75% of all carriers with G2DS disease symptoms), the median
age of onset is 17 years (range 0-78 years) and myelodysplastic syndrome
(MDS) is the first diagnosis in 75% of these cases with acute myeloid
leukemia (AML) in a further 9%. All variant types appear to predispose
to myeloid malignancy and immunodeficiency. Apart from lymphedema in
which haploinsufficiency seems necessary, the mutational requirements of
the other less common G2DS phenotypes is still unclear. These
predominantly loss-of-function variants impact GATA2 expression and
function in numerous ways including perturbations to DNA binding,
protein structure, protein:protein interactions, and gene transcription,
splicing and expression. In this review, we provide the first expert
curated ACMG/AMP classification with codes of published variants
compatible for use in clinical or diagnostic settings.