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George TI, Bajel A. Diagnosis of rare subtypes of acute myeloid leukaemia and related neoplasms. Pathology 2021; 53:312-327. [PMID: 33676766 DOI: 10.1016/j.pathol.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The diagnosis of acute myeloid leukaemia and related neoplasms in adults is challenging as this requires the integration of clinical findings, morphology, immunophenotype, cytogenetics, and molecular genetic findings. Lack of familiarity with rare subtypes of acute leukaemia hinders the diagnosis. In this review, we will describe diagnostic findings of several rare acute myeloid leukaemias and related neoplasms that primarily occur in adults including information on presentation, morphology, immunophenotype, genetics, differential diagnosis, and prognosis. Leukaemias discussed include blastic plasmacytoid dendritic cell neoplasm, acute myeloid leukaemia with t(6;9) (p23;q34.1); DEK-NUP214, acute myeloid leukaemia with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM, acute myeloid leukaemia with BCR-ABL1, acute leukaemias of ambiguous lineage, acute myeloid leukaemia with mutated RUNX1, pure erythroid leukaemia, acute panmyelosis with myelofibrosis, and acute basophilic leukaemia. Case studies with morphological features of the nine subtypes of acute myeloid leukaemia and related neoplasms have been included, and additional evidence available since publication of the 2016 World Health Organization Classification has been added to each subtype.
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Affiliation(s)
- Tracy I George
- University of Utah School of Medicine, Department of Pathology, Salt Lake City, UT, USA.
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre, The Royal Melbourne Hospital, Melbourne, Vic, Australia
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2
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Patel SH, Vasu S, Guo L, Lemaster O, Byrd JC, Walker A. Molecular Complete Remission Following Ivosidenib in a Patient With an Acute Undifferentiated Leukemia. J Natl Compr Canc Netw 2021; 18:6-10. [PMID: 31910380 DOI: 10.6004/jnccn.2019.7368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022]
Abstract
Acute undifferentiated leukemia (AUL) is a subtype of acute leukemias of ambiguous lineage. There is no standard treatment approach for AUL, although acute lymphoblastic leukemia-like regimens for induction therapy have been used. Additional data suggest that AUL may be better treated as acute myeloid leukemia (AML), given their similarities in genetic, cytogenetic, and gene expression patterns. Somatic mutations of IDH1 are found in 7% to 14% of patients with AML; however, the patient in this study was the first patient with IDH1-mutated AUL treated with ivosidenib. In this case, a woman aged 39 years was found to have anemia and thrombocytopenia after presenting to her primary care physician with fatigue, weight loss, and persistent infections. During further workup of the cytopenia, she was diagnosed with AUL and received 7+3 (daunorubicin, 60 mg/m2/d intravenously on days 1-3, and cytarabine, 100 mg/m2 24-hour continuous intravenous infusion on days 1-7) due to the presence of the IDH1 mutation. Bone marrow biopsy performed on day 14 of 7+3 showed persistent disease, and ivosidenib was initiated due to severe HLA alloimmunization (panel-reactive antibody, 100%) and significant bleeding complications. The patient achieved a complete morphologic and molecular remission on ivosidenib monotherapy despite critical bleeding complications during induction. Targeted therapy using ivosidenib may represent an encouraging therapeutic option in patients with AUL and IDH1 mutations. Additional evaluation of ivosidenib in this subgroup of patients with AUL is needed.
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Affiliation(s)
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, and
| | - Ling Guo
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Olivia Lemaster
- Division of Hematology, Department of Internal Medicine, and
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, and
| | - Alison Walker
- Division of Hematology, Department of Internal Medicine, and
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3
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Patel SS, Weinberg OK. Diagnostic workup of acute leukemias of ambiguous lineage. Am J Hematol 2020; 95:718-722. [PMID: 32124470 DOI: 10.1002/ajh.25771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/22/2022]
Abstract
Acute leukemias of ambiguous lineage (ALAL) comprise acute undifferentiated leukemias (AUL) and mixed-phenotype acute leukemias (MPAL). In the revised fourth edition of the World Health Organization (WHO) classification provided further refinements to the diagnostic criteria for ALAL. Molecular characterization of MPALs using comprehensive next-generation sequencing (NGS) has provided insights into their underlying biology and enabled a deeper understanding of ALAL classification. This review addresses the various components of pathologic assessment to establish a diagnosis of ALAL, and to further subclassify individual cases as AUL or MPAL, with an emphasis on the most up-to-date revisions to diagnostic criteria. In addition, key issues related to the detection of minimal residual disease (MRD) in ALALs and MPALs, and recently uncovered novel molecular diagnostic findings that may be helpful in better distinguishing various types of MPALs from each other, and from their "non-mixed" phenotypic correlates, are also discussed.
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Affiliation(s)
- Sanjay S. Patel
- Division of HematopathologyWeill Cornell Medical College New York New York USA
| | - Olga K. Weinberg
- Department of PathologyBoston Childrenʼs Hospital Boston Massachusetts USA
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4
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Kurzer JH, Weinberg OK. Acute Leukemias of Ambiguous Lineage: Clarification on Lineage Specificity. Surg Pathol Clin 2020; 12:687-697. [PMID: 31352981 DOI: 10.1016/j.path.2019.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Acute leukemias of ambiguous lineage (ALAL) include acute undifferentiated leukemia and mixed-phenotype acute leukemia (MPAL). This article provides an overview of the diagnosis of ALAL and focuses on the data accounting for the current lineage-assignment criteria for blasts harboring more than one lineage-associated marker. In addition, the currently known molecular data are reviewed, which show that MPAL-associated gene mutations, methylation signatures, and expression profiles are a mixture of those seen in both acute myeloid leukemia and acute lymphoblastic leukemia. Finally, the prognosis and current treatments of MPAL are briefly discussed.
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Affiliation(s)
- Jason H Kurzer
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Room 1401K, Stanford, CA 94305, USA.
| | - Olga K Weinberg
- Department of Pathology, Boston Children's Hospital, BCH 3027, 300 Longwood Avenue Bader 126.2, Boston, MA 02115, USA
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5
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Weinberg OK, Hasserjian RP, Baraban E, Ok CY, Geyer JT, Philip JKSS, Kurzer JH, Rogers HJ, Nardi V, Stone RM, Garcia JS, Hsi ED, Bagg A, Wang SA, Orazi A, Arber DA. Clinical, immunophenotypic, and genomic findings of acute undifferentiated leukemia and comparison to acute myeloid leukemia with minimal differentiation: a study from the bone marrow pathology group. Mod Pathol 2019; 32:1373-1385. [PMID: 31000771 DOI: 10.1038/s41379-019-0263-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 01/11/2023]
Abstract
Acute undifferentiated leukemia is a rare type of acute leukemia that shows no evidence of differentiation along any lineage. Clinical, immunophenotypic and genetic data is limited and it is uncertain if acute undifferentiated leukemia is biologically distinct from acute myeloid leukemia with minimal differentiation, which also shows limited myeloid marker expression and has been reported to have a poor prognosis. We identified 92 cases initially diagnosed as acute undifferentiated leukemia or acute myeloid leukemia with minimal differentiation from pathology databases of nine academic institutions with available diagnostic flow cytometric data, cytogenetic findings, mutational and clinical data. Outcome analysis was performed using Kaplan Meier test for the 53 patients who received induction chemotherapy. Based on cytogenetic abnormalities (N = 30) or history of myelodysplastic syndrome (N = 2), 32 cases were re-classified as acute myeloid leukemia with myelodysplasia related changes. The remaining 24 acute undifferentiated leukemia patients presented with similar age, blood counts, bone marrow cellularity, and blast percentage as the remaining 30 acute myeloid leukemia with minimal differentiation patients. Compared to acute myeloid leukemia with minimal differentiation, acute undifferentiated leukemia cases were characterized by more frequent mutations in PHF6 (5/15 vs 0/19, p = 0.016) and more frequent expression of TdT on blasts (p = 0.003) while acute myeloid leukemia with minimal differentiation cases had more frequent CD123 expression (p = 0.042). Outcome data showed no difference in overall survival, relapse free survival, or rates of complete remission between acute undifferentiated leukemia and acute myeloid leukemia with minimal differentiation groups (p > 0.05). Acute myeloid leukemia with myelodysplasia-related changes patients showed shorter survival when censoring for bone marrow transplant as compared to acute undifferentiated leukemia (p = 0.03) and acute myeloid leukemia with minimal differentiation (p = 0.002). In this largest series to date, the acute undifferentiated leukemia group shows distinct characteristics from acute myeloid leukemia with minimal differentiation, including more frequent PHF6 mutations and expression of TdT.
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Affiliation(s)
- Olga K Weinberg
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA.
| | | | - Ezra Baraban
- Department of Pathology and Laboratory Medicine, the University of Pennsylvania, Philadelphia, PA, USA
| | - Chi Young Ok
- Departments of Hematopathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Julia T Geyer
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - John K S S Philip
- Department of Pathology and Laboratory Medicine, University of Chicago, Chicago, IL, USA
| | - Jason H Kurzer
- Department of Pathology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jacqueline S Garcia
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, the University of Pennsylvania, Philadelphia, PA, USA
| | - Sa A Wang
- Departments of Hematopathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Attilio Orazi
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - Daniel A Arber
- Department of Pathology and Laboratory Medicine, University of Chicago, Chicago, IL, USA
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6
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KAKIMOTO ATSUSHI, OTSUBO KAORI, HANAWA MASAKO, KUWABARA TAKANORI, FUTAKI-SANBE TOMOKO, SAITO HAJIME, OHSAKA AKIMICHI. Acute Undifferentiated Leukemia or Minimally Differentiated Acute Myeloid Leukemia: Further Emphasis on Molecular Analysis in Leukemia Diagnosis. JUNTENDO IJI ZASSHI 2016. [DOI: 10.14789/jmj.62.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- ATSUSHI KAKIMOTO
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Faculty of Medicine
- Center for Genetic and Chromosomal Analysis, SRL Inc
| | - KAORI OTSUBO
- Center for Genetic and Chromosomal Analysis, SRL Inc
| | | | | | | | | | - AKIMICHI OHSAKA
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Faculty of Medicine
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7
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Manola KN. Cytogenetic abnormalities in acute leukaemia of ambiguous lineage: an overview. Br J Haematol 2013; 163:24-39. [DOI: 10.1111/bjh.12484] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kalliopi N. Manola
- Laboratory of Health Physics & Enviromental Health; Department of Cytogenetics; National Centre for Scientific Research (NCSR) “Demokritos”; Aghia Paraskevi; Athens; Greece
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8
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Acute leukemias of ambiguous lineage in adults: molecular and clinical characterization. Ann Hematol 2013; 92:747-58. [DOI: 10.1007/s00277-013-1694-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/30/2013] [Indexed: 12/27/2022]
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9
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Vardiman JW. The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues: an overview with emphasis on the myeloid neoplasms. Chem Biol Interact 2009; 184:16-20. [PMID: 19857474 DOI: 10.1016/j.cbi.2009.10.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 10/15/2009] [Indexed: 12/16/2022]
Abstract
The World Health Organization (WHO) classification of myeloid and lymphoid neoplasms utilizes morphology, immunophenotype, genetics and clinical features to define disease entities of clinical significance. It is a consensus classification in which a number of experts have agreed on the classification and diagnostic criteria. In general, the classification stratifies neoplasms according to their lineage (myeloid, lymphoid, histiocytic/dendritic) and distinguishes neoplasms of precursor cells from those comprised of functionally mature cells. Lymphoid neoplasms are derived from cells that frequently have features that recapitulate stages of normal B-, T-, and NK-cell differentiation and function, so to some extent they can be classified according to the corresponding normal counterpart, although additional features, such as genotype, clinical features and even location of the tumor figure into the final classification listing as well. Five major subgroups of myeloid neoplasms are recognized based mainly on their degree of maturation and biologic properties: myeloproliferative neoplasms (MPNs) which are comprised primarily of mature cells with effective proliferation; myeloid (and lymphoid) neoplasms with eosinophilia and abnormalities of PDGFRA, PDGFRB and FGFR1, defined largely by the finding of significant eosinophilia and specific genetic abnormalities; myelodysplastic/myeloproliferative neoplasms (MDS/MPN), comprised mainly of mature cells with both effective and ineffective proliferation of various lineages; myelodysplastic syndromes (MDS), in which immature and mature cells are found with abnormal, dysplastic and ineffective maturation, and acute myeloid leukemia (AML), comprised of precursor cells with impaired maturation. Genetic abnormalities play an important role as diagnostic criteria for further sub-classification of some myeloid neoplasms, particularly of AML. Although therapy-related MDS and AML (t-MDS/AML) often have genetic defects identical to those found in de novo AML and de novo MDS, they are classified separately from de novo AML and MDS in order to emphasize their unique clinical and biologic properties.
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Affiliation(s)
- James W Vardiman
- University of Chicago Medical Center, 5841 South Maryland Avenue, MC0008, Chicago, IL 60637, United States.
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10
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The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 2009; 114:937-51. [PMID: 19357394 DOI: 10.1182/blood-2009-03-209262] [Citation(s) in RCA: 3081] [Impact Index Per Article: 205.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recently the World Health Organization (WHO), in collaboration with the European Association for Haematopathology and the Society for Hematopathology, published a revised and updated edition of the WHO Classification of Tumors of the Hematopoietic and Lymphoid Tissues. The 4th edition of the WHO classification incorporates new information that has emerged from scientific and clinical studies in the interval since the publication of the 3rd edition in 2001, and includes new criteria for the recognition of some previously described neoplasms as well as clarification and refinement of the defining criteria for others. It also adds entities-some defined principally by genetic features-that have only recently been characterized. In this paper, the classification of myeloid neoplasms and acute leukemia is highlighted with the aim of familiarizing hematologists, clinical scientists, and hematopathologists not only with the major changes in the classification but also with the rationale for those changes.
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11
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Qadir M, Barcos M, Stewart CC, Sait SNJ, Ford LA, Baer MR. Routine immunophenotyping in acute leukemia: Role in lineage assignment and reassignment. CYTOMETRY PART B-CLINICAL CYTOMETRY 2006; 70:329-34. [PMID: 16739218 DOI: 10.1002/cyto.b.20112] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diagnostic evaluation of acute leukemia at Roswell Park Cancer Institute has routinely included immunophenotyping by multiparameter flow cytometry. In a retrospective analysis of 646 cases, morphology and cytochemistry established lineage in 612, but not in 34 (5%), of which 26, 5, and 3 were myeloid, undifferentiated, and lymphoid, respectively, based on immunophenotyping. In addition, immunophenotyping changed the lineage assigned based on morphology and cytochemistry in 11 cases (2%); 8 changed from lymphoid to myeloid, and 3 from myeloid to lymphoid. The data support routine inclusion of at least limited immunophenotyping in the diagnostic evaluation of acute leukemia.
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Affiliation(s)
- Misbah Qadir
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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12
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Abstract
Robertsonian translocations are the most common constitutional structural abnormalities but are rarely reported as acquired aberrations in hematologic malignancies. The nonhomologous acrocentric rearrangements are designated as Robertsonian translocations, whereas the homologous acrocentric rearrangements are referred to as isochromosomes. Robertsonian rearrangements have the highest mutation rates of structural chromosome rearrangements based on surveys of newborns and spontaneous abortions. It would be expected that Robertsonian recombinations would be more common than suggested by the literature. A survey of the cytogenetics database from a single institution found 17 patients with acquired Robertsonian rearrangement and hematologic malignancies. This is combined with data from the literature for a total of 237 patients. All of the possible types of Robertsonian rearrangements have been reported in hematologic malignancies, with the i(13q), i(14q), and i(21q) accounting for nearly 60%. Complex karyotypic changes are seen in the majority of cases, corresponding with disease evolution. These karyotypes consistently show loss of chromosomes 5 and/or 7 in the myelocytic disorders, nonacrocentric isochromosomes, and centromeric breakage and reunion. However, nearly 25% of the acquired rearrangements were found as the sole abnormality or in addition to an established cytogenetic aberration. Most of these were the i(14q) with the myelodysplasia subtypes refractory anemia and chronic myelomonocytic leukemia.
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Affiliation(s)
- Jeanna Welborn
- Department of Internal Medicine and Pathology, University of California at Davis Medical Center Cancer Center, Room 3017, 4501 X Street, Sacramento, CA 95817 USA.
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13
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Spirito FR, Mancini M, Derme V, Cimino G, Testi AM, Tafuri A, Vitale A, Foà R. Trisomy 13 in a patient with common acute lymphoblastic leukemia: description of a case and review of the literature. CANCER GENETICS AND CYTOGENETICS 2003; 144:69-72. [PMID: 12810259 DOI: 10.1016/s0165-4608(02)00924-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Trisomy 13 occurring as a single cytogenetic abnormality has been associated with undifferentiated or biphenotypic acute leukemias and with an adverse prognostic outcome. We describe for the first time a case of B-cell common acute lymphoblastic leukemia (ALL) with trisomy 13 at diagnosis in an 18-year-old boy. The leukemic cells did not express myelocytic or T-cell associated antigens and no molecular abnormalities were detected. Following treatment, according to the GIMEMA ALL 0496 protocol, the patient achieved a brief (2 months) complete remission. At relapse, cytogenetic analysis showed karyotypic evolution that included two novel subclones carrying a del(6q), a del(7q), and an add(17q) in association with trisomy 13. In addition, immunophenotypic analysis revealed the coexpression of the CD33 and CD7 antigens on common ALL blasts, in accordance with other reported cases that displayed a predominant biphenotypic leukemia profile. The patient failed to obtain a second remission and died soon after due to infective complications. This report indicates that trisomy 13 can be found also in B-lineage ALL and underlines that this cytogenetic abnormality may identify a subgroup of male patients with clonal evolution potential and an adverse clinical outcome.
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Affiliation(s)
- Francesca R Spirito
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Via Benevento 6, 00161 Rome, Italy.
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Ito Y, Hakoda Y, Iwase O, Okabe S, Uchida Y, Kimura Y, Kodama A, Fukutake K, Ohyashiki K. First Japanese case of sole trisomy 13 anomaly in acute myeloid leukemia. CANCER GENETICS AND CYTOGENETICS 2000; 120:85-6. [PMID: 10939844 DOI: 10.1016/s0165-4608(99)00243-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Wong KF, So CC, Kwong YL. Chronic myelomonocytic leukemia with t(7;11)(p15;p15) and NUP98/HOXA9 fusion. CANCER GENETICS AND CYTOGENETICS 1999; 115:70-2. [PMID: 10565304 DOI: 10.1016/s0165-4608(99)00085-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Translocation (7;11)(p15;p15) is a recently characterized chromosomal abnormality that results in fusion of the NUP98 gene on 11p15 and the HOXA9 gene on 7p15. It shows a strong racial predisposition, being found predominantly in Oriental patients, and has been reported almost exclusively in acute myeloid leukemia, often with associated myelodysplastic changes. In this report, we describe the unique occurrence of t(7;11)(p15;p15) and NUP98/HOXA9 fusion in a patient with chronic myelomonocytic leukemia, and suggest that the genetic lesion may involve multipotential myeloid stem cells.
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Affiliation(s)
- K F Wong
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
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16
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Mehta AB, Bain BJ, Fitchett M, Shah S, Secker-Walker LM. Trisomy 13 and myeloid malignancy--characteristic blast cell morphology: a United Kingdom Cancer Cytogenetics Group survey. Br J Haematol 1998; 101:749-52. [PMID: 9674750 DOI: 10.1046/j.1365-2141.1998.00760.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We retrospectively report data on 28 patients with haematological malignancy and trisomy 13 (25 cases) or tetrasomy 13 (three cases) as the primary acquired cytogenetic change. Peripheral blood and/or bone marrow morphology was reviewed in 25/28 cases and the final diagnosis was as follows: AML M0 (11), AML M1 (6), AML M2 (2), AML M4 (2), AML M5b (1), AML M6 (1), RAEB-t (3), RAEB (1), RA (1). All three cases with tetrasomy 13 had AML M0. Characteristic small hand-mirror blasts with cytoplasmic blebs and tails and scanty small granules were seen in 13/25 cases and 18/25 cases had small blasts which could easily be mistaken for lymphoblasts. Trilineage dysplasia was present in 8/28 cases. Median patient survival was 3 months. We conclude that trisomy 13 is particularly associated with acute myeloid leukaemia with minimal differentiation (AML MO), often has distinctive morphological features, and has a poor prognosis.
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Affiliation(s)
- A B Mehta
- Department of Haematology, Royal Free Hospital and Royal Free University College London School of Medicine
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