A variant t(X;15)(p11;q22) translocation in acute promyelocytic leukemia

Acute promyelocytic leukemia with t(15;16;17;19) and unusual fluorescence in situ hybridization pattern with PML and RARA probes

We report a 58-year-old female with typical morphological and clinical features of acute promyelocytic leukemia in whom a complex translocation involving chromosomes 15, 16, 17 and 19 was detected using conventional cytogenetics and fluorescence in situ hybridization (FISH) with chromosome specific paints. RARA-PML fusion was not evident by FISH, but the RARA signal was split in 74.5% of cells. GTL-banding and FISH with probes for PML, RARA and chromosome 15 specific paint raise the possibility of PML-RARA fusion on the abnormal chromosome 19 in the complex translocation. The unusual PML-RARA fusion may be related to this patient's poor response to induction therapy with all-trans-retinoic acid.

Molecular analysis of simple variant translocations in acute promyelocytic leukemia

The primary cytogenetic abnormality in acute promyelocytic leukemia (APL; FAB M3) is a reciprocal translocation, t(15;17)(q22;q12), which serves to fuse the PML gene on chromosome 15 to the retinoic acid receptor alpha (RARA) gene on chromosome 17. A PML-RARA fusion message transcribed from the der(15) is thought to mediate leukemogenesis. Two APL patients with simple variants of this translocation, t(3;15)(q21;q22) and t(X;15)(p11;q22), have previously been reported who lack cytogenetic involvement of chromosome 17, although their breakpoint positions on chromosome 15 still suggest the involvement of the PML gene. Here we report on a combined analysis by molecular genetics and in situ hybridization of these two patients, in which we wanted to determine whether the PML gene has alternative fusion partners or whether cryptic rearrangement of the RARA locus has occurred instead. A cryptic involvement of RARA was demonstrated in both patients by a combination of Southern analysis, reverse transcription coupled to PCR (RT-PCR), and fluorescence in situ hybridization. The results indicate an absolute requirement for the rearrangement of the RARA gene in the pathogenesis of APL and underline the importance of RARA during normal myeloid differentiation.

Detection of the PML/RAR alpha fusion gene in acute promyelocytic leukemia with a complex translocation involving chromosomes 15, 17, and 18

We report a case with typical clinical features of acute promyelocytic leukemia (APL) carrying an atypical chromosomal aberration involving chromosomes 15, 17, and 18. Molecular analysis using Southern blot hybridization and reverse transcriptase-polymerase chain reaction (RT-PCR) proved the creation of the PML/RAR alpha fusion gene in this case. These findings support the notion that this fusion is of crucial importance to leukemogenesis of APL.

A new variant translocation 11;17 in a patient with acute promyelocytic leukemia together with t(7;12)

Bone marrow cells from the majority of patients with acute promyelocytic leukemia (APL) are characterized by t(15;17)(q22;q11-12). At least 12 variant translocations have both also reported, and in each case, either abnormal chromosome 15 or del(17q) or both were involved in complex rearrangements. We report a patient with APL showing two translocations without apparent involvement of chromosome 15 and without del(17q). The karyotype was 46,XY,t(7;12)(p15;p13),t(11;17)(q13;q12). Rearrangement involving t(11;17) is probably associated with APL, while t(7;12) appears to be therapy related.