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Zhang Z, Xu Y, Jiang M, Kong F, Chen Z, Liu S, Li F. Identification of a new cryptic PML-RARα fusion gene without t(15;17) and biallelic CEBPA mutation in a case of acute promyelocytic leukemia: a case detected only by RT-PCR but not cytogenetics and FISH. Cancer Biol Ther 2020; 21:309-314. [PMID: 31959056 DOI: 10.1080/15384047.2019.1702398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is characterized by the presence of promyelocytic leukemia-retinoic acid receptor α (PML-RARα) fusion gene, which is formed following the specific chromosomal translocation t(15;17)(q22;q21). However, cases with PML-RARα generated by occult t(15;17) which are negative by both cytogenetics and fluorescence in situ hybridization (FISH), are difficult to diagnose, leading to impaired treatment effectiveness. In the present study, we reported a case of a 66-year-old male patient, and bone marrow morphology, flow cytometry and cytogenetics did not support the diagnosis of APL. Molecular techniques, such as reverse-transcription polymerase chain reaction (RT-PCR), showed the existence of a cryptic PML-RARα fusion gene, and sequence analysis revealed a new variable isoform. Hotspot gene mutation analysis showed a biallelic CEBPA mutation. He received IA chemotherapy and all-trans retinoic acid (ATRA) treatment, and finally achieved complete remission. This case report provided valuable insights into the relevance of the correct identification of atypical PML-RARα fusion gene and biallelic CEBPA mutation. Moreover, combination of IA chemotherapy and ATRA treatment suggested a good clinical effect in this atypical PML-RARα.
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Affiliation(s)
- Zhanglin Zhang
- Department of Clinical Laboratory, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yawen Xu
- Department of Hematology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mei Jiang
- Department of Clinical Laboratory, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fancong Kong
- Department of Hematology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhiwei Chen
- Department of Hematology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuyuan Liu
- Department of Clinical Laboratory, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fei Li
- Department of Hematology, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Zhou J, Zhao JW, Zheng YC, Xiao J, Li CW. [Cytogenetic test and clinical study on cryptic acute promyelocytic leukemia with ins (15; 17)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:843-847. [PMID: 31775484 PMCID: PMC7364981 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the genetic screening methods for cryptic acute promyelocytic leukemia (APL) to further explore its clinical prognosis. Methods: From June 2016 to November 2018, we collected 373 newly diagnosed APL cases. The patients were retrospected by the results of PML-RARα detections both by RT-PCR and i-FISH, those who harbored positive PML-RARα detection by RT-PCR and negative by i-FISH were chosen. Metaphase FISH and Sanger sequencing were further performed to verify these results. Results: A total of 7 cryptic APL cases were discovered. These cases had tiny fragment of RARα inserted into PML in chromosome 15, formed ins (15;17) . The 7 cryptic APL cases had no PML-RARα gene subtype specificity, involving 5 cases in L subtype, 1 case in S subtype and 1 case in V subtype respectively. After the treatment of retinoic acid and arsenic or anthracyclines, 6 cases achieved complete remission, 1 case died of intracranial hemorrhage on the 6th day of therapy. Conclusion: The size and covering position of PML-RARα probe should be taken into account when PML-RARα was performed by FISH on APL patients. Furthermore, combination with Metaphase FISH could improve the recognition of cryptic APL. There were no differences between the cryptic and common APL patients in terms of clinical features and treatment choices. Cryptic APL patients also had a good response to the therapy of retinoic acid and arsenic or anthracyclines.
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Affiliation(s)
- J Zhou
- Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Tianjin 300020, China
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Inamura J, Ikuta K, Tsukada N, Hosoki T, Shindo M, Sato K. Acute Promyelocytic Leukemia with i(17)(q10). Intern Med 2016; 55:3341-3345. [PMID: 27853080 PMCID: PMC5173505 DOI: 10.2169/internalmedicine.55.7226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a rare chromosomal abnormality observed in an acute promyelocytic leukemia (APL) patient. She had several APL derivative clones including a clone with i(17)(q10) abnormality, which consists of two kinds of structural abnormalities, a cryptic translocation of t(15;17) and an isochromosome of 17q. Although an obvious microscopic t(15;17) change was not observed on either arms of the isochromosome, PML/RARα fusion signals were detected on an interphase fluorescence in situ hybridization analysis. By several cytogenetic analyses of her bone marrow cells, it was confirmed that the i(17)(q10) clone was derived from the classic t(15;17) clone via another intervening clone, cryptic t(15;17).
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Affiliation(s)
- Junki Inamura
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Japan
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Shepshelovich D, Oniashvili N, Parnes D, Klein A, Muchtar E, Yeshaya J, Aviram A, Rabizadeh E, Raanani P. Acute promyelocytic leukemia with isochromosome 17q and cryptic PML-RARA successfully treated with all-trans retinoic acid and arsenic trioxide. Cancer Genet 2015; 208:575-9. [PMID: 26471811 DOI: 10.1016/j.cancergen.2015.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
Acute promyelocytic leukemia (APL) is a subtype of acute leukemia that is characterized by typical morphology, bleeding events and distinct chromosomal aberrations, usually the t(15;17)(q22;q21) translocation. Approximately 9% of APL patients harbor other translocations involving chromosome 17, such as the t(11;17)(q23;q21), t(5;17)(q35;q12-21), t(11;17)(q13;q21), and der(17). All-trans retinoic acid (ATRA) and arsenic trioxide (ATO) have specific targeted activities against the PML-RARA fusion protein. The combination of ATRA and ATO is reportedly superior to chemotherapy and ATRA as induction therapy for APL. The clinical significance of non-t(15:17) APL-related aberrations is controversial, with conflicting reports regarding sensitivity to modern, targeted therapy. Isochromosome 17q (iso(17q)) is rarely associated with APL and usually occurs concurrently with the t(15:17) translocation. No published data is available regarding the efficacy of ATO-based therapy for APL patients who harbor iso(17q). We report on an APL patient with iso(17q) as the sole cytogenetic aberration and a cryptic PML-RARA transcript, who was treated with ATRA and ATO after failure of chemotherapy and achieved complete remission. To our knowledge, this is the first published report of APL associated with iso(17q) as the sole cytogenetic aberration, which was successfully treated with an ATO containing regimen.
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Affiliation(s)
- Daniel Shepshelovich
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nino Oniashvili
- Cytogenetic Laboratory, Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Doris Parnes
- Hematological Laboratories, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Alina Klein
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Eli Muchtar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Josepha Yeshaya
- Cytogenetic Laboratory, Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Adina Aviram
- Hematological Laboratories, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Esther Rabizadeh
- Hematological Laboratories, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Hemato-Oncology Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Pia Raanani
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Paul Y. Dextromethorphan: problems with formulations. Indian Pediatr 2015; 51:1019. [PMID: 25560166 DOI: 10.1007/s13312-014-0551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Yash Paul
- A-D-7, Devi Marg, Bani Park, Jaipur, Rajasthan, India.
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Hahm C, Han SH, Mun YC, Seong CM, Chung WS, Huh J. ETV6/RUNX1 rearrangement identified by RT-PCR without evidence on FISH. Acta Haematol 2014; 132:122-4. [PMID: 24557455 DOI: 10.1159/000356778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/14/2013] [Indexed: 01/19/2023]
Affiliation(s)
- Chorong Hahm
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
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Alayed K, Medeiros LJ, Schultz RA, Cortes J, Lu G, Bueso-Ramos CE, Konoplev S. Value of oligonucleotide-based array comparative genomic hybridization for diagnosis of acute promyelocytic leukemia in a patient negative for t(15;17)(q24.1;q21.2)/promyelocytic leukemia-retinoic acid receptor, alpha by conventional cytogenetics and fluorescence in situ hybridization. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2013; 13:507-510. [PMID: 23770155 PMCID: PMC4259115 DOI: 10.1016/j.clml.2013.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/28/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Khaled Alayed
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | - Jorge Cortes
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Gary Lu
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Carlos E. Bueso-Ramos
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Sergej Konoplev
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
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Modified Array-based Comparative Genomic Hybridization Detects Cryptic and Variant PML-RARA Rearrangements in Acute Promyelocytic Leukemia Lacking Classic Translocations. ACTA ACUST UNITED AC 2013; 22:10-21. [DOI: 10.1097/pdm.0b013e31825b8326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Acute promyelocytic leukemia with trisomy 8 showing normal PML-RARA FISH signal patterns: diagnostic application of long-distance polymerase chain reaction in molecularly discrepant leukemia cases. Ann Hematol 2012; 91:1645-8. [DOI: 10.1007/s00277-012-1439-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/22/2012] [Indexed: 01/26/2023]
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10
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Lewis C, Patel V, Abhyankar S, Zhang D, Ketterling RP, McClure RF, Persons DL. Microgranular variant of acute promyelocytic leukemia with normal conventional cytogenetics, negative PML/RARA FISH and positive PML/RARA transcripts by RT-PCR. Cancer Genet 2012; 204:522-3. [PMID: 22018276 DOI: 10.1016/j.cancergen.2011.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/03/2011] [Indexed: 11/29/2022]
MESH Headings
- Adult
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Cytogenetic Analysis
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Nuclear Proteins/genetics
- Promyelocytic Leukemia Protein
- RNA, Messenger
- Receptors, Retinoic Acid/genetics
- Retinoic Acid Receptor alpha
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription Factors/genetics
- Translocation, Genetic
- Tumor Suppressor Proteins/genetics
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Kim MJ, Cho SY, Kim MH, Lee JJ, Kang SY, Cho EH, Huh J, Yoon HJ, Park TS, Lee WI, Marschalek R, Meyer C. FISH-negative cryptic PML–RARA rearrangement detected by long-distance polymerase chain reaction and sequencing analyses: a case study and review of the literature. ACTA ACUST UNITED AC 2010; 203:278-83. [DOI: 10.1016/j.cancergencyto.2010.08.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 08/24/2010] [Accepted: 08/28/2010] [Indexed: 10/18/2022]
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12
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Kim M, Lee SA, Park HI, Oh EJ, Park CW, Lim J, Han K, Kim Y. Two distinct clonal populations in acute promyelocytic leukemia, one involving chromosome 17 and the other involving an isochromosome 17. ACTA ACUST UNITED AC 2010; 197:185-8. [PMID: 20193853 DOI: 10.1016/j.cancergencyto.2008.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 08/22/2008] [Indexed: 11/18/2022]
Abstract
Acute promyelocytic leukemia (APL) is characterized by a t(15;17)(q22;q21) rearrangement. Additional chromosomal rearrangements have been reported in 25-40% of APL patients. The most common abnormality involving chromosome 17 is ider(17). Here we report the case of a patient with APL with isochromosome 17q combined with ider(17), confirmed by fluorescence in situ hybridization. Cytogenetic data strongly suggest that the involvement of chromosomes 15 and 17 in translocation occurs after formation of the isochromosome 17. The case reported here presents the novel finding of two separate clonal events apparently occurring at the same time in an APL patient.
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Affiliation(s)
- Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul, Korea
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13
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Kim KE, Woo KS, Kim SH, Han JY. Detection of PML/RARA Rearrangement by Reverse Transcriptase-PCR and Sequencing in a Case of Microgranular Acute Promyelocytic Leukemia Lacking t(15;17) on Karyotype and FISH. Ann Lab Med 2009; 29:379-83. [DOI: 10.3343/kjlm.2009.29.5.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kyung-Eun Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kwang-Sook Woo
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jin-Yeong Han
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
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