Background and Objectives Shwachman Diamond Syndrome (SDS) is an inherited bone marrow failure syndrome (IBMFS) associated with pancreatic insufficiency, neutropenia, and skeletal dysplasia. Biallelic pathogenic variants (PV) in SBDS account for >90% of SDS. We hypothesized that the SDS phenotype varies based on genotype and conducted a genotype-phenotype correlation study to better understand these complexities. Methods We reviewed records of all patients with SDS or SDS-like syndromes in the National Cancer Institute’s (NCI) IBMFS study. Additional published SDS cohorts were reviewed and compared with the NCI cohort. Results PVs in SBDS were present in 32/47 (68.1%) participants. Biallelic inheritance of SBDS c.258+2T>C and c.183_184TA>CT was the most common genotype in our study (25/32, 78.1%) and published cohorts. Most patients had the SDS hallmark features of neutropenia (45/45, 100%), pancreatic insufficiency (41/43, 95.3%), and/or bony abnormalities (29/36, 80.6%). Developmental delay was common (20/34, 58.8%). Increased risk of hematologic malignancies at young ages and the rarity of solid malignancies was observed in both the NCI cohort and published studies. Conclusions SDS is a complex childhood illness with a narrow genotypic spectrum. Patients may first present to primary care, gastroenterology, orthopedic, and/or hematology clinics. Coordinated multidisciplinary care is important for diagnosis and patient management.

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Background Fanconi anemia (FA) is an inherited bone marrow failure syndrome associated with characteristic dysmorphology primarily caused by biallelic pathogenic germline variants in any of 22 different DNA repair genes. There are limited data on the specific molecular causes of FA in different ethnic groups. Methods We performed exome sequencing and copy number variant analyses on 19 patients with FA from 17 families undergoing hematopoietic cell transplantation evaluation in Pakistan. The scientific literature was reviewed, and we curated germline variants reported in patients with FA from South Asia and the Middle East. Results The genetic causes of FA were identified in 14 of the 17 families: seven FANCA, two FANCC, one FANCF, two FANCG, and two FANCL. Homozygous and compound heterozygous variants were present in 12 and two families, respectively. Nine families carried variants previously reported as pathogenic, including two families with the South Asian FANCL founder variant. We also identified five novel likely deleterious variants in FANCA, FANCF, and FANCG in affected patients. Conclusions Our study supports the importance of determining the genomic landscape of FA in diverse populations, in order to improve understanding of FA etiology and assist in the counseling of families.

Objectives Adolescents and young adult (AYA) cancer survivors face unique medical and psychosocial sequalae, including chronic health conditions, late effects of treatment and fear of recurrence. The meaning of cancer survivorship may be further complicated for AYAs with hereditary cancer predisposition syndromes. This study used a patient‐centered framework to investigate how AYAs with Li‐Fraumeni syndrome (LFS) consider cancer survivorship. Methods An interprofessional team conducted 30 semi‐structured interviews with AYAs (aged 18–41, mean 31 years) enrolled in the National Cancer Institute's LFS Study (NCT01443468). Twenty had experienced at least one cancer diagnosis. Interview data were thematically analyzed by an inter‐professional team using interpretive description and grounded theory methods. Findings Participants viewed “survivorship” as a period marked by no evidence of formerly diagnosed disease. By contrast, participants felt the label “survivor” was tenuous since LFS is characterized by multiple primary malignancies and uncertainty about intervals between one diagnosis and the next. Many AYAs viewed survivorship as requiring a high degree of suffering. Though many personally rejected “survivor” identities, almost all articulated its various functions including positive, negative, and more complicated connotations. Instead, they chose language to represent a range of beliefs about survival, longevity, prognosis, and activism. Conclusions AYAs with LFS struggle with the term “survivor” due to their multi‐organ cancer risk, short intervals between malignancies, and evolving identities. Loved ones' cancer‐related suffering informed perspectives on survivorship. Survivorship care for AYAs with cancer risk syndromes requires interprofessional interventions that address their unique biomedical and psychosocial needs.

Background Fanconi anemia (FA), a cancer-prone inherited bone marrow failure syndrome associated with characteristic dysmorphology is primarily caused by autosomal recessive inheritance of pathogenic germline variants in any of 22 different DNA repair genes. Pathogenic variants in FANCA are the most frequent cause, followed by FANCC and FANCG. There are limited data on the specific molecular causes of FA in different ethnic groups. Methods We evaluated 19 patients with FA undergoing hematopoietic cell transplantation evaluation, from 17 families in Pakistan with exome sequencing and copy number variant analysis. To accompany these efforts, we reviewed the literature and curated a list of variants reported in patients with FA from South Asia and the Middle East.Results The genetic causes for disease were identified in 14 families: 7 FANCA, 2 FANCC, 1 FANCF, 2 FANCG, and 2 FANCL. Homozygous and compound heterozygous variants were present in 12 and 2 families, respectively. Nine families carried variants previously reported as pathogenic, including two families with the South Asian FANCL founder variant. We also identified five novel likely deleterious variants in FANCA, FANCF, and FANCG in affected patients. Conclusions Our study supports the importance of determining the genomic landscape of FA in diverse populations, in order to improve understanding of FA etiology and assist in the counseling of families.