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Xie J, Nachabe A, Hathaway LJ, Farah B, Berbari B, Li Y, Brown TC, Schmid JL, Socola F, Saba NS, Safah H. The prognostic implications of tetraploidy/near-Tetraploidy in acute myeloid leukemia: a case series and systematic review of the literature. Leuk Lymphoma 2021; 62:203-210. [PMID: 32993375 DOI: 10.1080/10428194.2020.1817435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/23/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
The prognostic significance and optimal management of tetraploidy/near-tetraploidy acute myeloid leukemia (T/NT AML) remains unclear given its limited data. This is especially true after factoring in additional chromosomal alterations, which carry their own prognostic weight. Here, we analyze 128 cases of T/NT in AML from the literature along with two additional cases, which is the largest review of this subject to date. Based on our retrospective analysis, we found that regardless of the risk status attributed to cytogenetics, the prognosis of tetraploid or near-tetraploid AML is dismal and should be incorporated within the unfavorable risk group. Complete remission is paramount to survival in this population. Specific induction protocols for high-risk AML appear to have higher rates of complete remission in the T/NT AML population. Moreover, longer overall survival can be achieved with chemotherapy followed by allogeneic stem cell transplantation at first complete remission.
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Affiliation(s)
- John Xie
- Deming Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Bachir Farah
- Southern Illinois Healthcare, Carterville, IL, USA
| | | | - Yuwen Li
- Hayward Genetics Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Theresa C Brown
- Hayward Genetics Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Janet L Schmid
- Department of Pathology, Tulane University, New Orleans, LA, USA
| | - Francisco Socola
- Section of Hematology and Medical Oncology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nakhle S Saba
- Section of Hematology and Medical Oncology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hana Safah
- Section of Hematology and Medical Oncology, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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2
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Yang R, Jiang M, Zhao J, Chen H, Gong J, You Y, Song L, Li Z, Li Q. Identification of chromosomal abnormalities and genomic features in near-triploidy/tetraploidy-acute leukemia by fluorescence in situ hybridization. Cancer Manag Res 2019; 11:1559-1567. [PMID: 30863166 DOI: 10.2147/cmar.s189025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Near-triploidy/tetraploidy is rarely found in acute leukemia. Only limited data are available to characterize this condition, and it remains largely unknown. Patients and methods In our study, we performed karyotype analysis on 1,031 patients diagnosed with acute leukemia from 2006 to 2018. A total of 10 patients of near-triploidy/tetraploidy karyotype were enrolled. Two cases of near-triploidy (66-79 chromosomes) and eight cases of near-tetraploidy (84-100 chromosomes) were identified. Bone marrow samples of these 10 patients were analyzed by fluorescence in situ hybridization with 19 commercially available probes that detected a small portion of gene alterations and large regions of chromosome amplifications. Results Of the six patients with acute myelocytic leukemia, we detected three cases of double t(8;21)(q22;q22) that have not been previously reported, and one of them demonstrated ins(21;8) (q22;q24q22). We also describe a novel pediatric case carrying double t(15;17)(q22;q21) and receiving targeted treatment with all-trans retinoic acid therapy. To date, this case has responded well to the regimen and has shown continuous complete remission. All patients received chemotherapy. One of them received allogeneic hematopoietic stem cell transplant (HSCT) and survived for 22 months. Eight of the 10 patients died, and the median overall survival was 11 months. Conclusion Using fluorescence in situ hybridization, we identified the distinct complex karyotype of near-triploidy/tetraploidy and provided further prognostic information. Tetraploidy acute promyelocytic leukemia had favorable prognosis; thus, HSCT was not necessary. The case of insertion t(21;8)(q22;q24q22) in tetraploidy responded poorly to chemotherapy and achieved molecular remission with difficultly. Data from patients in this group indicated that near-triploidy/tetraploidy acute leukemia has poor prognosis and new therapy is urgently needed.
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Affiliation(s)
- Ruqing Yang
- Reproductive Medicine Center, Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Minghua Jiang
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China,
| | - Junzhao Zhao
- Reproductive Medicine Center, Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hui Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China,
| | - Jian Gong
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China,
| | - Yaying You
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Laiyue Song
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhen Li
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, Guangdong 510150, China,
| | - Qian Li
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China,
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Jurisic V, Pavlovic S, Colovic N, Djordjevic V, Jankovic G, Colovic M. Acute Myeloid Leukemia Associated With Near-Tetraploid Karyotype and Mutations in the FLT3 Gene. Lab Med 2011. [DOI: 10.1309/lm6e0cqqpokxxg4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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4
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Im M, Lee JK, Lee DY, Hong YJ, Hong SI, Kang HJ, Chang YH. [Near-tetraploidy acute myeloid leukemia with RUNX1-RUNX1T1 rearrangement due to cryptic t(8;21)]. Korean J Lab Med 2010; 29:510-4. [PMID: 20046081 DOI: 10.3343/kjlm.2009.29.6.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tetraploidy or near-tetraploidy is a rare cytogenetic abnormality found in AML, and is divided into primary and secondary forms. The secondary tetraploidy or near-tetraploidy found in AML is known to be specifically associated with t(8;21). In this case report, FISH analysis detected RUNX1-RUNX1T1 gene rearrangement in the absence of cytogenetic abnormality of t(8;21), which suggests the presence of unvailed t(8;21). This is the first case report of tetraploidy or near-tetraploidy AML with cryptic RUNX1/RUNX1T1 in Korea. Although the prognosis of tetraploidy or near- tetraploidy with t(8;21) is known to be poor, this patient shows a relatively good clinical course compared to other reported cases.
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Affiliation(s)
- Mijeong Im
- Department of Laboratory Medicine, Korea Cancer Center Hospital, Seoul, Korea
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5
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Single institute study of FLT3 mutation in acute myeloid leukemia with near tetraploidy in Serbia. J Genet 2009; 88:149-52. [DOI: 10.1007/s12041-009-0022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Pelosini M, Benedetti E, Galimberti S, Caracciolo F, Petrini M, Fazzi R, Andreazzoli F, Papineschi F. Granulocytic sarcoma and subsequent acute leukemia recurrence with different biologic characteristics 5 years after allogeneic bone marrow transplantation for acute myeloid leukemia. Bone Marrow Transplant 2006; 37:897-8. [PMID: 16547489 DOI: 10.1038/sj.bmt.1705344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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7
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Imkie M, Davis MK, Persons DL, Cunningham MT. Biphasic acute myeloid leukemia with near-tetraploidy and immunophenotypic transformation. Arch Pathol Lab Med 2004; 128:448-51. [PMID: 15043460 DOI: 10.5858/2004-128-448-bamlwn] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This report describes a case of acute myeloid leukemia (subtype M1) with biphasic morphology. The bone marrow biopsy showed 2 distinct regions of blasts, one containing large cells and the other small cells. Morphometric and DNA ploidy analysis showed that the mean nuclear area and mean DNA index for the large cell region were 2-fold higher than those for the small cell region. Cytogenetic analysis showed an abnormal near-tetraploid clone. The tumor relapsed following aggressive therapy. The cells from the relapse specimen were similar to the original small cell region with respect to nuclear area and DNA index; however, there was immunophenotypic transformation with gain of CD7 and gain of CD56. Cytogenetically, the relapse specimen showed no evidence of the near-tetraploid clone, but instead had a previously unidentified abnormal clone containing 46 chromosomes and structural abnormalities of 2q and 7q. Biphasic morphology in acute myeloid leukemia may be predictive of a near-tetraploid subclone and immunophenotypic transformation.
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MESH Headings
- Adult
- Aneuploidy
- Antigens, CD/analysis
- Antigens, CD7/analysis
- Antigens, Neoplasm/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- CD56 Antigen/analysis
- Cell Size
- Chromosome Deletion
- Chromosomes, Human, Pair 7/ultrastructure
- Cytarabine/administration & dosage
- DNA, Neoplasm/analysis
- Daunorubicin/administration & dosage
- Fatal Outcome
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Neoplasm Recurrence, Local/pathology
- Peripheral Blood Stem Cell Transplantation
- Transplantation, Autologous
- Transplantation, Homologous
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Affiliation(s)
- Marwa Imkie
- Department of Pathology, University of Kansas Medical Center, Kansas City, Kan 66223, USA
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8
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Morita Y, Takahashi A, Yamamoto K, Miki T, Murakami N, Miura O. Secondary near-tetraploidy with double der(15)t(15;17) in acute promyelocytic leukemia in relapse. ACTA ACUST UNITED AC 2004; 149:131-6. [PMID: 15036889 DOI: 10.1016/j.cancergencyto.2003.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Accepted: 07/29/2003] [Indexed: 11/30/2022]
Abstract
Tetraploidy or near-tetraploidy is a rare cytogenetic abnormality in acute myelocytic leukemia. We report here a case of acute promyelocytic leukemia that showed near-tetraploidy with double der(15)t(15;17) the leukemia relapsed. At diagnosis, cytogenetic analysis failed to reveal any karyotypic abnormality; however, a promyelocytic leukemia-retinoic acid receptor alpha (PML/RARA) fusion transcript of the bcr3-type was detected with reverse transcriptase-polymerase chain reaction analysis, and a single PML/RARA fusion signal was observed with fluorescence in situ hybridization analysis. At the first relapse, the majority of leukemic cells showed pseudodiploid karyotypes with der(15)t(15;17), as well as additional chromosomal abnormalities, and exhibited a single PML/RARA fusion signal. A small fraction of leukemic cells, however, showed near-tetraploid karyotypes with double der(15)t(15;17), as well as some additional chromosomal abnormalities in common with the pseudodiploid clones, and exhibited double PML/RARA fusion signals. At the second and third relapses, leukemic cells with near-tetraploidy and double PML/RARA fusion signals became predominant. The PML/RARA fusion transcript of the bcr3 type was also observed at each relapse. In addition, Southern blot analysis of the RARA gene at diagnosis and at the second relapse showed a common rearranged band. Notably, giant, bizarre, and hypogranular promyelocytes expressing CD2, CD34, and HLA-DR appeared at the first relapse and became predominant at the second and third relapses. These observations indicate that the APL cells with near-tetraploidy and double der(15)t(15;17) clonally evolved from the pseudodiploid leukemic cells and exhibited the bizarre morphology and aberrant surface immunophenotypes.
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Affiliation(s)
- Yuriko Morita
- Department of Hematology and Oncology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan
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9
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Kojima K, Imaoka M, Noguchi T, Narumi H, Uchida N, Sakai I, Yasukawa M, Fujita S. Hypocellular acute promyelocytic leukemia with a tetraploid clone characterized by two t(15;17). CANCER GENETICS AND CYTOGENETICS 2003; 145:169-71. [PMID: 12935930 DOI: 10.1016/s0165-4608(03)00097-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a case of hypocellular acute promyelocytic leukemia with a tetraploid clone characterized by two t(15;17). The large leukemia cells had a bizarre nuclear configuration and multiple Auer rods. A bone marrow biopsy specimen revealed a markedly hypocellular marrow (<10% cellularity) in the absence of myelofibrosis. Myelodysplastic features were not detected. Chromosome analysis of marrow cells revealed a karyotype of 92,XXYY,del(2)(q?),t(15;17)(q22;q21)x2. Interphase fluorescence in situ hybridization revealed that the marrow cells were composed of a tetraploid clone carrying double t(15;17) and normal diploid cells. The leukemia responded well to all-trans retinoic acid. We think that the tetraploidy could be caused by endoreduplication or endomitosis of the diploid clone with single t(15;17). The unique karyotype largely contributed to the cell morphology and marrow hypoplasia, while it may not have affected on the prognosis of the acute promyelocytic leukemia.
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Affiliation(s)
- Kensuke Kojima
- The First Department of Internal Medicine, Ehime University School of Medicine, Shingenobu, Ehime 791-0295, Japan.
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10
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Oh SH, Park TS, Kim HH, Chang CL, Lee EY, Son HC, Chung JS, Cho GJ. Tetraploid acute promyelocytic leukemia with double t(15;17) and PML/RARA rearrangements detected by fluorescence in situ hybridization analysis. CANCER GENETICS AND CYTOGENETICS 2003; 145:49-53. [PMID: 12885462 DOI: 10.1016/s0165-4608(03)00035-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acute promyelocytic leukemia (APL) is characterized by a serious hemorrhagic syndrome, unique morphologic findings, and its response to retinoids. Tetraploidy is a very rare chromosomal abnormality in acute myelocytic leukemia. This report presents a unique case of APL with a tetraploid clone characterized by two t(15;17) without other chromosomal changes, as well as PML/RARA rearrangements confirmed fluorescence in situ hybridization. The morphology of the blast cells was that of the classic M3 subtype, but the mean blast size exceeded that of control APL cases with diploidy. A chromosomal study revealed a 92,XXXX,t(15;17)(q22;q21)x2 karyotype in all 20 metaphase spreads. Despite all-trans-retinoic acid (ATRA) treatment and chemotherapy, leukemic cells persisted in the blood, and the patient died of an intracranial hemorrhage on the 16th day after admission.
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MESH Headings
- Aneuploidy
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Promyelocytic, Acute/genetics
- Middle Aged
- Neoplasm Proteins/genetics
- Nuclear Proteins
- Oncogene Proteins, Fusion/genetics
- Promyelocytic Leukemia Protein
- Receptors, Retinoic Acid/genetics
- Retinoic Acid Receptor alpha
- Transcription Factors/genetics
- Translocation, Genetic
- Tumor Suppressor Proteins
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Affiliation(s)
- Seung Hwan Oh
- Department of Laboratory Medicine, Pusan National University, Pusan 602-739, Korea
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