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de Souza DC, de Figueiredo AF, Ney Garcia DR, da Costa ES, Othman MAK, Liehr T, Abdelhay E, Silva MLM, de Souza Fernandez T. A unique set of complex chromosomal abnormalities in an infant with myeloid leukemia associated with Down syndrome. Mol Cytogenet 2017; 10:35. [PMID: 28912835 PMCID: PMC5594429 DOI: 10.1186/s13039-017-0335-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022] Open
Abstract
Background Children with Down syndrome (DS) have an enhanced risk of developing acute leukemia, with the most common subtype being acute megakaryoblastic leukemia (AMKL). Myeloid leukemia in Down syndrome (ML-DS) is considered a disease with distinct clinical and biological features. There are few studies focusing on the clonal cytogenetic changes during evolution of ML-DS. Case presentation Here, we describe a complex karyotype involving a previously unreported set of chromosomal abnormalities acquired during progression of ML-DS in an infant boy: derivative der(1)t(1;15)(q24;q23), translocation t(4;5)(q26;q33) and derivative der(15)t(7;15)(p21;q23). Different molecular cytogenetic probes and probesets including whole chromosome painting (WCP) and locus specific probes, as well as, multicolor-FISH and multicolor chromosome banding (MCB) were performed in order to characterize the chromosomal abnormalities involved in this complex karyotype. The patient was treated according to the acute myeloid leukemia-Berlin-Frankfurt-Munich-2004 (AML-BFM 2004) treatment protocol for patients with Down syndrome; however, he experienced a poor clinical outcome. Conclusion The molecular cytogenetic studies performed, allowed the characterization of novel chromosomal abnormalities in ML-DS and possible candidate genes involved in the leukemogenic process. Our findings suggest that the complex karyotype described here was associated with the poor prognosis.
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Affiliation(s)
- Daiane Correa de Souza
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, National Cancer Institute (INCA), Praça Cruz Vermelha no. 23, 6° andar. Centro, CEP, Rio de Janeiro, RJ 20230-130 Brazil
| | - Amanda Faria de Figueiredo
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, National Cancer Institute (INCA), Praça Cruz Vermelha no. 23, 6° andar. Centro, CEP, Rio de Janeiro, RJ 20230-130 Brazil
| | - Daniela R Ney Garcia
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, National Cancer Institute (INCA), Praça Cruz Vermelha no. 23, 6° andar. Centro, CEP, Rio de Janeiro, RJ 20230-130 Brazil
| | - Elaine Sobral da Costa
- Pediatric and Puericulture Martagão Gesteira Institute, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-590 Brazil
| | - Moneeb A K Othman
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, 07743 Jena, Germany
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, 07743 Jena, Germany
| | - Eliana Abdelhay
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, National Cancer Institute (INCA), Praça Cruz Vermelha no. 23, 6° andar. Centro, CEP, Rio de Janeiro, RJ 20230-130 Brazil
| | - Maria Luiza Macedo Silva
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, National Cancer Institute (INCA), Praça Cruz Vermelha no. 23, 6° andar. Centro, CEP, Rio de Janeiro, RJ 20230-130 Brazil
| | - Teresa de Souza Fernandez
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, National Cancer Institute (INCA), Praça Cruz Vermelha no. 23, 6° andar. Centro, CEP, Rio de Janeiro, RJ 20230-130 Brazil
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Angelova S, Spassov B, Nikolova V, Christov I, Tzvetkov N, Simeonova M. Is amplification of c-MYC, MLL and RUNX1 genes in AML and MDS patients with trisomy 8, 11 and 21 a factor for a clonal evolution in the karyotype? CYTOL GENET+ 2015. [DOI: 10.3103/s0095452715030032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cytogenetic features of acute lymphoblastic and myeloid leukemias in pediatric patients with Down syndrome: an iBFM-SG study. Blood 2008; 111:1575-83. [DOI: 10.1182/blood-2007-09-114231] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Children with Down syndrome (DS) have a markedly increased risk of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). To identify chromosomal changes cooperating with +21 that may provide information on the pathogenesis of these leukemias, we analyzed 215 DS-ALLs and 189 DS-AMLs. Unlike previous smaller series, a significant proportion of DS-ALLs had the typical B-cell precursor ALL abnormalities high hyperdiploidy (HeH; 11%) and t(12;21)(p13;q22) (10%). The HeH DS-ALLs were characterized by gains of the same chromosomes as non–DS-HeH, suggesting the same etiology/pathogenesis. In addition, specific genetic subtypes of DS-ALL were suggested by the significant overrepresentation of cases with +X, t(8;14)(q11;q32), and del(9p). Unlike DS-ALL, the common translocations associated with non–DS-AML were rare in DS-AML, which instead were characterized by the frequent presence of dup(1q), del(6q), del(7p), dup(7q), +8, +11, del(16q), and +21. This series of DS leukemias—the largest to date—reveals that DS-ALL is a heterogeneous disorder that comprises both t(12;21) and HeH as well as DS-related abnormalities. Furthermore, this analysis confirms that DS-AML is a distinct entity, originating through other genetic pathways than do non–DS-AMLs, and suggests that unbalanced changes such as dup(1q), +8, and +21 are involved in the leukemogenic process.
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Mitelman F, Heim S, Mandahl N. Trisomy 21 in neoplastic cells. AMERICAN JOURNAL OF MEDICAL GENETICS. SUPPLEMENT 2005; 7:262-6. [PMID: 2149959 DOI: 10.1002/ajmg.1320370752] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Trisomy 21 as an acquired clonal chromosome change has been described in 642 of the 10,625 human neoplasms with chromosome aberrations known from the cytogenetic literature. A total of 590 of the 642 cases (92%) are hematologic disorders and malignant lymphomas. The incidence of trisomy 21 is similar (4.1%-6.7%) in acute myeloid leukemia (AML), chronic myeloid leukemia, myeloproliferative disorders, myelodysplastic syndromes, chronic lymphoproliferative disorders, and malignant lymphomas; it is substantially higher (14.8%) in acute lymphocytic leukemia (ALL). In most cases, the extra chromosome 21 is present together with other numerical and/or structural changes. Acquired trisomy 21 is the only karyotypic abnormality in only 0.4%. Trisomy 21 has never been reported as the sole anomaly in a solid tumor. The cytogenetic literature contains information on 62 patients with constitutional trisomy 21 and a malignant disorder in which the tumor cells have been analyzed by banding techniques. Thirty-four of the 62 patients had AML, 16 had ALL, and 2 had acute undifferentiated leukemia. The 52 leukemic Down syndrome (DS) cases account for 1.4% of the total acute leukemias, an overrepresentation that parallels the generally increased risk of leukemia development in DS. Sixty-three percent of the ALL patients and 79% of those with AML had additional changes superimposed on constitutional trisomy 21. These included several of the characteristic primary leukemia-associated aberrations: 5q-, 7q-, +8, and t(8;21) in AML, and t(1;19), t(4;11), 6q-, and 14q + in ALL. Thus, it seems that the pattern of acquired karyotypic changes is similar in patients with DS and in individuals with a normal constitutional karyotype.
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Affiliation(s)
- F Mitelman
- Department of Clinical Genetics, University of Lund, Sweden
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Forestier E, Heim S, Blennow E, Borgström G, Holmgren G, Heinonen K, Johannsson J, Kerndrup G, Andersen MK, Lundin C, Nordgren A, Rosenquist R, Swolin B, Johansson B. Cytogenetic abnormalities in childhood acute myeloid leukaemia: a Nordic series comprising all children enrolled in the NOPHO-93-AML trial between 1993 and 2001. Br J Haematol 2003; 121:566-77. [PMID: 12752097 DOI: 10.1046/j.1365-2141.2003.04349.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between 1993 and 2001, 318 children were diagnosed with acute myeloid leukaemia (AML) in the Nordic countries. The patient group comprised 237 children < 15 years of age with de novo AML, 42 children < 15 years with Down syndrome (DS) and de novo AML, 18 adolescents 15-18 years of age with de novo AML, and 21 children < 15 years with treatment-related AML (t-AML). The first group was all-inclusive, yielding an annual childhood de novo AML incidence of 0.7/100 000. Cytogenetic analyses were successful in 288 cases (91%), and clonal chromosomal abnormalities were detected in 211 (73%). The distribution of ploidy levels were pseudodiploidy (55%), hyperdiploidy (34%) and hypodiploidy (11%). The most common aberrations (> 2%) were + 8 (23%) (as a sole change in 6.2%), 11q23-translocations, including cryptic MLL rearrangements (22%) [t(9;11)(p21-22;q23) in 11%], t(8;21)(q22;q22) (9.0%), inv(16)(p13q22) (6.2%), -7/7q- (5.2%), and t(15;17)(q22;q12) (3.8%). Except for +8, these abnormalities were rare in group 2; only one DS patient had a t(8;21) and none had 11q23-translocations, t(15;17) or inv(16). In the t-AML group, three cases displayed 11q23-rearrangements, all t(9;11); and there were no t(8;21), t(15;17) or inv(16). Overall, the observed frequencies of t(8;21) and t(15;17) were lower, and frequencies of trisomy 8 and 11q23-translocations higher, than in previous studies. Furthermore, seven abnormalities that were previously reported as only single AML cases were also seen, meaning that der(4)t(4;11)(q26-27;q23), der(6)t(1;6)(q24-25;q27), der(7)t(7;11)(p22;q13), inv(8)(p23q11-12), t(11;17)(p15;q21), der(16)t(10;16)(q22;p13) and der(22)t(1;22)(q21;q13) are now classified as recurrent abnormalities in AML. In addition, 37 novel aberrations were observed, 11 of which were sole anomalies.
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Affiliation(s)
- Erik Forestier
- Departments of Clinical Sciences, Paediatrics, University of Umeå, Sweden.
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Salido M, Solé F, Espinet B, Fernández C, Zamora L, Woessner S, Florensa L. Pentasomy 21 with two isochromosomes 21 in a case of acute myeloid leukemia without maturation. CANCER GENETICS AND CYTOGENETICS 2002; 132:71-3. [PMID: 11801314 DOI: 10.1016/s0165-4608(01)00529-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Here, we report a 72-year-old male patient with acute myeloid leukemia (AML) without maturation. Cytogenetic study of a bone marrow culture revealed the following karyotype: 47,XX,+21,+i(21)(q10)x2. Fluorescence in situ hybridization study with a locus specific probe for 21q22 verified a pentasomy of 21q as a sole clonal cytogenetic abnormality. To our knowledge, this is the first report of pentasomy 21q in AML without Down syndrome.
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Affiliation(s)
- Marta Salido
- Laboratori de Citologia Hematològica, Escola de Citologia Hematològica S. Woessner-IMAS, Hospital del Mar, IMAS, IMIM, Barcelona, Spain.
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Liehr T, Beensen V, Starke H, Hauschild R, Hempell E, Fritsche V, Hoppe C, Grosswendt G, Prechtel M, Ziegler M, Claussen U, von Eggeling F. Tetrasomy 21 due to a de novo Robertsonian translocation t(14;21) and an additional free trisomy 21. Clin Genet 2001; 60:83-5. [PMID: 11531976 DOI: 10.1034/j.1399-0004.2001.600114.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ruymann FB, Grovas AC. Progress in the diagnosis and treatment of rhabdomyosarcoma and related soft tissue sarcomas. Cancer Invest 2001; 18:223-41. [PMID: 10754991 DOI: 10.3109/07357900009031827] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Advances in the diagnosis and treatment of rhabdomyosarcoma and related soft tissue sarcomas continue in the Intergroup Rhabdomyosarcoma Study Group (IRSG) and European cooperative groups. The use of molecular biology techniques in soft tissue sarcomas are redefining the classic pathology of these small blue cell tumors. Improvements in imaging, radiotherapy, and surgery, in part, deserve credit for the better survival seen in all cooperative trials. These advances confound the interpretation of consecutively run chemotherapy trials using historical comparisons. The IRSG has reported improvement in the prognosis of both nonmetastatic and metastatic embryonal rhabdomyosarcoma as attributable to three, three-drug regimens that use cyclophosphamide at 2.2 g/m2 in either maintenance or induction and maintenance therapy. Patients of any age with metastatic, nonembryonal, and those over 10 years of age with metastatic embryonal rhabdomyosarcoma continue to have a poor prognosis, which even megatherapy has failed to change. The doublet of ifosfamide and etoposide in combination with vincristine, actinomycin D, and cyclophosphamide at 2.2 g/m2 achieved a remarkable 3-year survival of 58% in patients with metastatic rhabdomyosarcoma and undifferentiated soft tissue sarcoma. The topoisomerase I inhibitor, topotecan, has recently been found by the IRSG to have a 57% overall response rate in patients with metastatic alveolar rhabdomyosarcoma. Topotecan has completed testing with cyclophosphamide in a phase II window study in newly diagnosed patients with metastatic disease and has been incorporated into a randomized trial in intermediate risk patients in IRSG-V. Molecular studies in IRSG-V will be applied in the detection of occult bone marrow metastases and the evaluation of resection margins at initial and second-look surgery. Long-term follow-up will be required in patients with gross residual sarcoma randomized to conventional and hyperfractionated radiotherapy in IRSG-IV to assess late effects. Although older patients with unfavorable histology and metastatic disease continue to have a poor prognosis, the overall 5-year survival of children and adolescents with nonmetastatic and metastatic rhabdomyosarcoma is approaching 80%. As molecular discoveries advance the diagnosis and detection of rhabdomyosarcoma, it is hoped that the futuristic molecular based treatment strategies in development and early testing will further improve survival in high-risk patients with metastatic soft tissue sarcoma.
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Lange B. The management of neoplastic disorders of haematopoiesis in children with Down's syndrome. Br J Haematol 2000; 110:512-24. [PMID: 10997960 DOI: 10.1046/j.1365-2141.2000.02027.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B Lange
- Division of Oncology, 3408 Wood Building, The Children's Hospital of Philadelphia, Philadelphia, PA 191904, USA.
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Satge D, Le Tourneau A, Verger JP, Lefort S, Geneix A, Malet P, Diebold J, Vekemans M. A case report of Down syndrome and centroblastic lymphoma. Pathol Res Pract 1996; 192:1266-9. [PMID: 9182298 DOI: 10.1016/s0344-0338(96)80165-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a case of left cervical stage I centroblastic lymphoma in a 29-year old male patient with Down's syndrome due to a (14; 21) Robertsonian translocation. The disease presented as extensive lymph node necrosis leaving rare areas of tumor cells, accounting for the diagnostic difficulties. According to our review of the literature, lymphoma is one of the most common neoplasms in DS patients and may represent the second most common malignancy in this condition, far behind leukemia.
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Affiliation(s)
- D Satge
- Laboratoire d'Anatomie Pathologique, CH Tulle, France
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Satge D, Van Den Berghe H. Aspects of the neoplasms observed in patients with constitutional autosomal trisomy. CANCER GENETICS AND CYTOGENETICS 1996; 87:63-70. [PMID: 8646744 DOI: 10.1016/0165-4608(95)00249-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A review of the literature reveals numerous clinical case reports, systematic histologic analyses, epidemiologic studies, and large series of tumors showing that subjects with trisomy 8, 9, 13, 18, and 21 have an excess of hematologic and various solid tumors compared to the general population. These tumors more frequently affect particular organs for a given type of trisomy. A large proportion of tumors are observed during fetal and neonatal life, are incompletely developed, and subsequently regress. In older children or even adults, tumors are less frequent, are often found on the same organs as earlier in life, are more aggressive, and do not involute. The mechanism responsible for the development of these neoplasms could be similar to that which generates the malformations in these children and may result from cooperation of the chromosomal abnormality with physiologic growth phenomena, which are particularly active early in life. Trisomic subjects must be carefully followed in order to detect tumors as early as possible and to allow treatment under optimal conditions.
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Affiliation(s)
- D Satge
- Laboratoire d'Anatomie Pathologique, Tulle, France
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Shekhter-Levin S, Mirro J, Penchansky L, Sherer ME, Wald N, Gollin SM. Acute myeloblastic leukemia with a pericentric inversion of chromosome 6 in a child with Down syndrome. CANCER GENETICS AND CYTOGENETICS 1994; 73:157-60. [PMID: 7986260 DOI: 10.1016/0165-4608(94)90201-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cytogenetic analysis of bone marrow cells demonstrated a pericentric inversion of chromosome 6 when acute myeloblastic leukemia (AML) was diagnosed in a 15-month-old child with Down syndrome. The abnormal clone with inv(6)(p24q16) was associated with FAB-M1 AML and disappeared when a complete remission was achieved. This is a unique cytogenetic abnormality for FAB-M1 AML in a child with Down syndrome and, to our knowledge, is only the second case of a pericentric inversion of chromosome 6 reported in AML.
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Affiliation(s)
- S Shekhter-Levin
- Department of Human Genetics, University of Pittsburgh, Children's Hospital of Pittsburgh, Pennsylvania
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Zipursky A, Thorner P, De Harven E, Christensen H, Doyle J. Myelodysplasia and acute megakaryoblastic leukemia in Down's syndrome. Leuk Res 1994; 18:163-71. [PMID: 8139285 DOI: 10.1016/0145-2126(94)90111-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In this report we describe the clinical and hematologic features of 23 cases of myelodysplasia (MDS) or acute megakaryoblastic leukemia (AMKL) occurring in Down's syndrome. MDS was characterized by thrombocytopenia, abnormal megakaryocytopoiesis, megakaryoblasts (< 30%) in the marrow and abnormal karyotype, the most common of which was trisomy 8, found in 7/15 patients with MDS. Three of five patients achieved a complete remission with low dose cytosine arabinoside, vincristine and retinyl palmitate. The high cure rate and the distinctive features of the leukemic process in these cases suggest that this type of MDS and AMKL are unique to patients with Down's syndrome.
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Affiliation(s)
- A Zipursky
- Department of Pediatrics, Hospital for Sick Children, Canada
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Sawyer JR, Roloson GJ, Head DR, Becton D. Karyotype evolution in a patient with Down syndrome and acute leukemia following a congenital leukemoid reaction. MEDICAL AND PEDIATRIC ONCOLOGY 1994; 22:404-9. [PMID: 8152402 DOI: 10.1002/mpo.2950220610] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report the serial cytogenetic study of a patient with Down syndrome who experienced a congenital leukemoid reaction, underwent a spontaneous remission within four months, and subsequently developed acute myeloid leukemia at 16 months. A blood chromosome study to rule out Down syndrome performed at age 24 days, during the leukemoid reaction, revealed a 47,XX,+21 karyotype. The diagnosis of acute leukemia was made at 16 months, at which time a chromosome study, on bone marrow, was performed. This analysis revealed a clonal karyotype of 47,XX,+21,-22,+der(22)t(1;22)(q21;q13) in all but one cell studied. The single apparently nonclonal cell showed a karyotype of 49,XX,+12,-13,-19,+der(19)t(19;?)(q11;?)x2,+21,+22. A third chromosome study at 19 months indicated the original leukemic clone with t(1;22) (q21;q13) had been replaced by the clone represented by the single cell with 49 chromosomes seen in the previous chromosome study. This case of an infant with Down syndrome and acute leukemia illustrated rapid evolution and a transitory nature to clonal chromosome aberrations while retaining AML morphology and course.
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Affiliation(s)
- J R Sawyer
- Department of Pathology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock 72202
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Penchansky L, Wollman MR, Gartner JC, Wenger SL. Spontaneous remission of infantile acute nonlymphocytic leukemia for 11 years in a child with normal karyotype. Cancer 1993; 71:1928-30. [PMID: 8448758 DOI: 10.1002/1097-0142(19930301)71:5<1928::aid-cncr2820710532>3.0.co;2-d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Leukemia or a leukemia-like picture in phenotypically normal infants with a normal marrow karyotype who undergo spontaneous remission is extremely unusual. RESULTS A 6-week-old, phenotypically normal boy first was seen in 1979 with hepatosplenomegaly, a 36 x 10(9)/l leukocyte count, a leukoerythroblastic picture, and increased blasts in the bone marrow aspirate. Because no other known causes of leukemoid reaction could be demonstrated, the picture was consistent at that time with acute nonlymphocytic leukemia (ANLL), French-American-British (FAB) M1; however, because of the age of the child, the low blast count, normal cytogenetics, and questions about this diagnosis, treatment was withheld. Hematologic laboratory values normalized by the time he was 1 year of age. Eleven years later, he presented a similar picture that rapidly progressed to overt leukemia (FAB M1). A normal marrow karyotype was consistent throughout the 11 years of follow-up. Treatment of ANLL was initiated, resulting in marrow remission. This was followed by allogeneic bone marrow transplantation. He had a relapse again and was retreated, achieving a second marrow remission, and had a second allogeneic bone marrow transplantation. However, the patient died of venoocclusive disease of the liver after the second transplant. CONCLUSION The diagnosis and prognosis of infants with an abnormal hematologic picture similar to ANLL but who are phenotypically and karyotypically normal are not as straightforward as in the older child or adult. Treatment should be withheld in this setting until the leukemic process is overt.
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Affiliation(s)
- L Penchansky
- Department of Pathology, School of Medicine, University of Pittsburgh, Pennsylvania
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Theodossiou C, Scalise A, Silverman L, Najfeld V. Chromosome 21 rearrangement in acute biphenotypic leukemia. ACTA ACUST UNITED AC 1992; 64:56-9. [PMID: 1360869 DOI: 10.1016/0165-4608(92)90323-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with myelodysplastic syndrome (MDS) and a 47,XY,+21 karyotype at diagnosis, was documented to have a clonal chromosome 21 rearrangement, i(21q), four months before transformation to acute biphenotypic leukemia. For 4 months after transformation, isochromosome 21 persisted while the patient was receiving treatment with zidovudine. Vitamin D3 was added to zidovudine for an additional month, during which time the trisomy 21 clone reappeared as the predominant cell population. The unique aspects of this patient are the atypical evolution of chromosome 21, the transformation to biphenotypic leukemia, and the occurrence of i(21q) associated with biphenotypic leukemia evolving from an MDS.
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MESH Headings
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/drug therapy
- Anemia, Refractory, with Excess of Blasts/genetics
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- CD13 Antigens
- Cell Transformation, Neoplastic
- Cholecalciferol/therapeutic use
- Chromosomes, Human, Pair 21
- Gene Expression Regulation, Leukemic
- Gene Rearrangement
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/genetics
- Receptors, Interleukin-2/analysis
- Trisomy
- Zidovudine/therapeutic use
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Affiliation(s)
- C Theodossiou
- Tumor Cytogenetics Laboratory, Poly Annenberg Levy Hematology Center, Mount Sinai School of Medicine, New York
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Sacchi N. Down syndrome and chromosome 21 abnormalities in leukaemia. BAILLIERE'S CLINICAL HAEMATOLOGY 1992; 5:815-31. [PMID: 1308166 DOI: 10.1016/s0950-3536(11)80047-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- N Sacchi
- Department of Biology and Genetics, School of Medicine, University of Milan, Italy
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Nowak MJ. Deletion 9p syndrome and malignancy: acquired vs. constitutional aberrations? AMERICAN JOURNAL OF MEDICAL GENETICS 1992; 44:244-5. [PMID: 1456300 DOI: 10.1002/ajmg.1320440226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Olegård C, Mandahl N, Heim S, Willén H, Leifsson B, Mitelman F. Embryonal rhabdomyosarcoma with 100 chromosomes but no structural aberrations. CANCER GENETICS AND CYTOGENETICS 1992; 60:198-201. [PMID: 1606566 DOI: 10.1016/0165-4608(92)90019-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An embryonal rhabdomyosarcoma was analyzed cytogenetically after short-term culturing. The tumor was located in the scrotum of an 18-year-old man who, at the age of 4, had been treated for a rhabdomyosarcoma in the orbita. The chromosome number was 100. No structural aberrations were present. There were 2-7 copies of each chromosome type with particular excess of chromosomes 8, 12, and 22, and a relative deficit of chromosome 15.
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Affiliation(s)
- C Olegård
- Department of Clinical Genetics, University Hospital, Lund, Sweden
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Slavc I, Urban C, Haas OA, Kroisel PM, Köller U. Acute megakaryocytic leukemia in children. Clinical, immunologic, and cytogenetic findings in two patients. Cancer 1991; 68:2266-72. [PMID: 1833041 DOI: 10.1002/1097-0142(19911115)68:10<2266::aid-cncr2820681027>3.0.co;2-b] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An unusual presentation of acute megakaryocytic leukemia (AMKL) is reported in two young children. The first child had a 10-day history of ptosis of the right eyelid as the initial manifestation of AMKL, a clinical picture not previously described in this variant of leukemia. Computed tomographic scanning showed multiple intracranial mass lesions, and the diagnosis of AMKL was confirmed by immunophenotyping of bone marrow blasts. The second child had Down syndrome and received alkylating agents and radiation therapy for treatment of metastatic rhabdomyosarcoma of the orbit. She had AMKL as second malignancy. Both patients had acquired chromosome 21 anomalies in their leukemic blasts. The first patient, constitutionally normal, had an i(21q) in his leukemic blasts; the patient with constitutional trisomy 21 had tetrasomy 21 and additional chromosomal changes. The clinical symptoms and the results of morphologic, immunologic, and cytogenetic studies are discussed.
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MESH Headings
- Blepharoptosis/etiology
- Bone Marrow Examination
- Brain Diseases/etiology
- Chromosome Banding
- Down Syndrome/complications
- Female
- Humans
- Immunophenotyping
- Infant
- Karyotyping
- Leukemia, Megakaryoblastic, Acute/complications
- Leukemia, Megakaryoblastic, Acute/diagnosis
- Leukemia, Megakaryoblastic, Acute/genetics
- Leukemia, Megakaryoblastic, Acute/immunology
- Leukocytes, Mononuclear/immunology
- Male
- Neoplasms, Second Primary
- Orbital Neoplasms/therapy
- Rhabdomyosarcoma/therapy
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Affiliation(s)
- I Slavc
- Department of Pediatrics, University of Graz, Austria
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23
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Abstract
The routine use of panels of monoclonal antibodies has been complementary to the French-American-British (FAB) leukemia classification, and has unmasked the occurrence of mixed acute leukemia (myeloid-lymphoid). It is widely accepted that children with Down's syndrome (DS) have a high incidence of acute leukemia. There is an extensive body of literature emphasizing the cytogenetic findings in these children. However, information as to the immunophenotype is often limited to the lymphoid surface determinants. The authors report two children with DS whose leukemic blasts were studied with a panel of 17 monoclonal antibodies (myeloid, lymphoid, and megakaryocytic) by flow cytometric examination and were classified as biphenotypic acute leukemia. The blast population coexpressed myeloid and T-cell surface markers. The lymphoid origin was ruled out on the basis of negative terminal deoxynucleotidyl transferase and molecular analysis demonstrating germline configuration for the JH and beta TCR genes.
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Affiliation(s)
- L Penchansky
- Department of Pathology, University of Pittsburgh, Pennsylvania
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Brothman AR, Ghosn C, Werner E. Pentasomy 21q in a neonatal case of acute myeloblastic leukemia. CANCER GENETICS AND CYTOGENETICS 1990; 47:135-7. [PMID: 2141542 DOI: 10.1016/0165-4608(90)90273-d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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25
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Bridge JA, Neff JR, Borek DA, Hackbarth DA. Primary skeletal Ewing's sarcoma in Down syndrome. CANCER GENETICS AND CYTOGENETICS 1990; 47:61-8. [PMID: 2141543 DOI: 10.1016/0165-4608(90)90263-a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Primary skeletal Ewing's sarcoma that occurred in two teenage patients with Down syndrome are reported. Cytogenetic analysis of one of these tumors showed the 11;22 translocation characteristic of Ewing's sarcoma as well as other complex karyotypic changes. The possible role of constitutional trisomy 21 in development of these sarcomas is discussed.
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Affiliation(s)
- J A Bridge
- Department of Pathology and Oncology, University of Kansas Medical Center, Kansas City 66103
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26
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Cook JA, Raney B, Innes DJ, Normansell D. Transient myeloproliferative disorder. In a neonate with Down syndrome. Immunophenotypic studies. Clin Pediatr (Phila) 1989; 28:132-5. [PMID: 2522030 DOI: 10.1177/000992288902800306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This report describes the results of bone marrow leukocyte immunophenotypic studies, DNA index measurement, and chromosome analysis in a newborn with Down syndrome and transient myeloproliferative disorder. The infant's initial leukocytosis with immature cells in the peripheral blood and thrombocytopenia resolved without treatment by 6 months of age, and he was well at 2 years of age. The lack of specific reactivity between the patient's morphologically immature cells and multiple monoclonal antibodies directed against lymphoid and myeloid leukemia cells may be characteristic of this disorder. Other cases should be examined for immunophenotype to correlate the results with chromosomal analysis and to provide a basis for comparison in those who subsequently develop true acute leukemia.
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Affiliation(s)
- J A Cook
- Division of Pediatric Hematology-Oncology, University of Virginia Medical Center, Charlottesville
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