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Tao S, Song L, Deng Y, Chen Y, Shi Y, Gan Y, Deng Z, Ding B, He Z, Wang C, Yu L. Acute Myeloid Leukemia with NUP98-RARG Gene Fusion Similar to Acute Promyelocytic Leukemia: Case Report and Literature Review. Onco Targets Ther 2020; 13:10559-10566. [PMID: 33116634 PMCID: PMC7574910 DOI: 10.2147/ott.s273172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
Retinoic acid receptor gamma (RARG) belongs to the nuclear receptor superfamily and has 90% homology to RAR alpha (RARA) and RAR beta. The promyelocytic leukemia (PML)–RARA fusion gene has been implicated in acute promyelocytic leukemia (APL). RARG gene rearrangement has been identified in a rare subtype of acute myeloid leukemia (AML) that resembles APL. To date, only 10 cases of gene rearrangements involving RARG (nucleoporin [NUP]98–RARG, promyelocytic leukemia protein–RARG, cleavage and polyadenylation-specific factor 6–RARG, or nucleophosmin [NPM]1–RARG–NPM1) have been reported. These patients show characteristics similar to APL, including bone marrow morphology, coagulation abnormality, and immunophenotype; however, they are resistant to all-trans retinoic acid and arsenic trioxide treatment. Moreover, there is no optimal therapeutic regimen for this subtype of AML. In this study, we report the clinical presentation and experimental findings of a case of AML with NUP98–RARG gene fusion similar to APL and review other cases of RARG gene rearrangement described in the literature.
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Affiliation(s)
- Shandong Tao
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Lixiao Song
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yuan Deng
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yue Chen
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yuye Shi
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Yimin Gan
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Zhikui Deng
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Banghe Ding
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Zhengmei He
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Chunling Wang
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
| | - Liang Yu
- Department of Hematology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, People's Republic of China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, People's Republic of China
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Klepin HD, Neuendorff NR, Larson RA, Hamaker ME, Breccia M, Montesinos P, Cordoba R. Treatment of acute promyelocytic leukemia in older patients: recommendations of an International Society of Geriatric Oncology (SIOG) task force. J Geriatr Oncol 2020; 11:1199-1209. [PMID: 32273246 DOI: 10.1016/j.jgo.2020.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/15/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Approximately one third of patients diagnosed with acute promyelocytic leukemia (APL) are above the age of sixty. It is important to ensure older adults receive optimal diagnosis and management since this subtype of acute myeloid leukemia - given appropriate treatment - is highly curable with lower risk of adverse events compared to other types of leukemia. Historically, older age has been a risk factor for early death and poorer overall survival. However, prospects have changed with the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). APL is curable in the majority of patients regardless of age, and the threshold of fitness that makes ATRA/ATO therapy possible is likely to be lower than for cytotoxic chemotherapy. APL frequently presents as a medical emergency and rapid diagnosis and intervention - typically involving referral to a specialist centre - is a major determinant of outcome. After diagnosis, management of APL in older adults presents particular challenges. Geriatric assessment, including evaluation of frailty, comorbidities and polypharmacy can assist in providing optimal supportive care for older adults during remission induction and may help individualize therapy in the post-remission phase. Here, we review the available evidence, highlighting areas of consensus, gaps in evidence and opportunities for research to enhance diagnosis, management and survivorship for older patients.
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Affiliation(s)
- Heidi D Klepin
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Nina Rosa Neuendorff
- University Hospital, Dept of Hematology, Oncology and Rheumatology, Heidelberg, Germany
| | - Richard A Larson
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, USA
| | - Marije E Hamaker
- Dept of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | | | - Pau Montesinos
- Hospital La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Raul Cordoba
- University Hospital Fundacion Jimenez Diaz, Madrid, Spain
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Conserva MR, Redavid I, Anelli L, Zagaria A, Specchia G, Albano F. RARG Gene Dysregulation in Acute Myeloid Leukemia. Front Mol Biosci 2019; 6:114. [PMID: 31709264 PMCID: PMC6822255 DOI: 10.3389/fmolb.2019.00114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Retinoic acid receptor γ (RARγ) belongs to the nuclear receptor superfamily and shares 90% homology with retinoic acid receptor α (RARα) and retinoic acid receptor β (RARβ). RARA rearrangements are well-known to be involved in acute promyelocytic leukemia (APL), but RARG rearrangements can also resemble this kind of leukemia. In this review we trace the role of RARγ, considering both its physiological and oncogenic contribution; from 2011 to date, nine cases of patients harboring RARG fusions have been reported. These patients showed typical APL features, including the clinical presentation, coagulation abnormalities and morphological features of bone marrow (BM), but are not responsive to APL standard therapy. We stress the urgent need for a better comprehension of the critical role of RARG dysregulation in the leukemogenesis process, since optimum therapy strategies have not yet been established.
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Affiliation(s)
- Maria Rosa Conserva
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Immacolata Redavid
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Luisa Anelli
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Antonella Zagaria
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Francesco Albano
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
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