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Jabbour E, Saglio G, Hughes TP, Kantarjian H. Suboptimal responses in chronic myeloid leukemia: implications and management strategies. Cancer 2011; 118:1181-91. [PMID: 22038681 PMCID: PMC3412948 DOI: 10.1002/cncr.26391] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/06/2011] [Indexed: 01/30/2023]
Abstract
The high response rates and increased survival associated with imatinib therapy prompted a paradigm shift in the management of chronic myeloid leukemia. However, 25% to 30% of imatinib-treated patients develop drug resistance or intolerance, increasing the risk of disease progression and poor prognosis. In 2006, the European LeukemiaNet proposed criteria to identify patients with a suboptimal response to, or failure associated with, imatinib; these recommendations were updated in 2009. Suboptimal responders represent a unique treatment challenge. Although they may respond to continued imatinib therapy, their long-term outcomes may not be as favorable as those for optimally responding patients. Validation studies demonstrated that suboptimal responders are a heterogeneous group, and that the prognostic implications of suboptimal response vary by time point. There are few data derived from clinical trials to guide therapeutic decisions for these patients. Clinical trials are currently underway to assess the efficacy of newer tyrosine kinase inhibitors in this setting. Identification of suboptimal responders or patients failing treatment using hematologic, cytogenetic, and molecular techniques allows physicians to alter therapy earlier in the treatment course to improve long-term outcomes.
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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2
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O'Brien S, Thall PF, Siciliano MJ. Cytogenetics of chronic myelogenous leukaemia. BAILLIERE'S CLINICAL HAEMATOLOGY 1997; 10:259-76. [PMID: 9376663 DOI: 10.1016/s0950-3536(97)80006-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Philadelphia (Ph) chromosome is present in the leukaemic cells of most patients with chronic myelogenous leukaemia. Variant translocations occur in 10% of patients but breakpoints on chromosomes 9 and 22 remain the same, so prognosis of these patients is unchanged. Clonal evolution is infrequent in chronic phase and its significance depends on the specific chromosome involved, the number of metaphases affected and the timing in the chronic phase. The majority of patients in blastic phase demonstrate clonal evolution; three specific abnormalities (+Ph, +8 and isochromosome 17q) are present in 70% of patients. Loss of the Ph chromosome on therapy is associated with prolonged survival. For monitoring these events conventional G-band cytogenetics (CG) is essential at presentation to characterize the Disease cytogenetically, while fluorescence in situ hybridization (FISH) on hypermetaphase preparations (hypermetaphase FISH (HMF)) is important for establishing the specific frequency of Ph+ cells. During treatment FISH on interphase cells (I-FISH) can monitor the level of Ph+ cells in circulation, while CG may be used to identify any suspected clonal evolution. Where I-FISH is negative, HMF is essential to evaluate minimal residual disease.
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Affiliation(s)
- S O'Brien
- Department of Hematology, University of Texas M.D. Anderson Cancer, Center, Houston 77030, USA
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3
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Hild F, Fonatsch C. Cytogenetic peculiarities in chronic myelogenous leukemia. CANCER GENETICS AND CYTOGENETICS 1990; 47:197-217. [PMID: 2357695 DOI: 10.1016/0165-4608(90)90030-e] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cytogenetic investigations were performed in 185 patients with chronic myelogenous leukemia (CML) at all stages of the disease; 166 patients were Ph positive-159 (95.8%) of these showing the standard Ph translocation, and 7 (4.2%) variant translocations-17 patients were Ph negative. In 2 patients the cytogenetic analysis was unsuccessful. Additional aberrations were found in 40 (24.1%) of the Ph-positive patients. Nine (52.9%) of the Ph-negative patients showed chromosome anomalies. Besides the well known nonrandom abnormalities (-7, +8, i(17q), +19, +Ph) we found a high frequency of clones with rare or not yet described structural rearrangements--in 14 cases (34.2%) of the Ph-positive patients and in 2 cases (20%) of the Ph-negative patients with other chromosome abnormalities. The clinical significance of these findings is discussed.
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Affiliation(s)
- F Hild
- Institut für Humanenetik, Medizinische Universität zu Lübeck, Federal Republic of Germany
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4
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Abe S, Minamihisamatsu M, Ishihara T, Sasaki M. Chromosomal in situ hybridization and Southern blot analyses using c-abl, c-sis, or bcr probe in chronic myelogenous leukemia cells with variant Philadelphia translocations. CANCER GENETICS AND CYTOGENETICS 1989; 38:61-74. [PMID: 2713815 DOI: 10.1016/0165-4608(89)90166-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The Philadelphia (Ph) chromosome is a cytogenetic hallmark of chronic myelogenous leukemia (CML). Whereas the majority of Ph-positive CML patients show the standard Ph translocation involving chromosomes 9 and 22, t(9;22)(q34;q11), the minority of cases exhibit a variant type of Ph translocation involving these two and other chromosomes (complex type) or those involving #22 and chromosomes other than #9 (simple type). To get an insight into the nature of variant Ph translocations and the process of their formation, we examined the localization of the c-abl and c-sis oncogenes and the breakpoint cluster region (bcr) gene by chromosomal in situ hybridization in ten variant Ph translocations of CML including five simple and five complex ones as initially interpreted. In situ hybridization showed that c-abl localized to band 9q34 and c-sis localized to band 22q12-q13 were translocated on the Ph and on one of the rearranged chromosomes other than #9, respectively, in all the variant translocations examined. On the other hand, bcr localized to band 22q11 was translocated on various chromosomes but mostly on chromosome 9. Parallel Southern blot analyses on DNA from leukemic cells of five patients including two with simple translocations and three with complex ones revealed rearrangements of bcr with breakpoints occurring mostly in a 5' portion of 5.8-kb BamHI/BglII sequences, which are quite similar to those detected so far in CML cases with the standard Ph translocation. The present findings strongly suggest that variant Ph translocations of CML are all complex, and some of them are formed stepwisely from the standard translocation.
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Affiliation(s)
- S Abe
- Chromosome Research Unit, Faculty of Science, Hokkaido University, Japan
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5
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Morris CM, Rosman I, Archer SA, Cochrane JM, Fitzgerald PH. A cytogenetic and molecular analysis of five variant Philadelphia translocations in chronic myeloid leukemia. CANCER GENETICS AND CYTOGENETICS 1988; 35:179-97. [PMID: 3180020 DOI: 10.1016/0165-4608(88)90240-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Three patients had complex translocations involving 9q34, 22q11, and a third chromosome (Xq11, 7q11.2, or 15q11.2). Two patients had apparently simple variant Philadelphia (Ph) translocations, t(19;22) and t(11;22), with no obvious involvement of chromosome 9, and the Ph was masked in the t(11;22). In situ hybridization studies showed transposition of the abl gene from chromosome 9q34 to the breakpoint cluster region (bcr) of chromosome 22 in all five patients; this was confirmed by rearrangements of the bcr gene in leukemic DNA. In situ hybridization also showed that the bcr-3' and c-sis probes consistently translocated to recipient chromosomes X, 1, 7, 11, and 15, whereas IgC lambda remained on chromosome 22q. These results confirm that association of abl and bcr is a consistent feature of chronic myeloid leukemia irrespective of the cytogenetic presentation and support the conclusion of Hagemeijer that all simple variant Ph translocations are, in fact, complex and involve at least three chromosomes.
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Affiliation(s)
- C M Morris
- Cancer Society of New Zealand Cytogenetics Unit, Christchurch Hospital
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6
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Kubota K, Arai T, Shirakura T, Takeda T. Erythrocytosis and complex Ph translocation 46,XY,t(9;11;22) in a patient with chronic myelogenous leukemia. CANCER GENETICS AND CYTOGENETICS 1987; 24:359-62. [PMID: 3466684 DOI: 10.1016/0165-4608(87)90119-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of chronic myelogenous leukemia in the chronic phase with erythrocytosis and a complex Ph translocation is described. The karyotype was 46,XY,t(9;11;22)(q34;q13;q11). The granulocytic and erythroid overgrowth was controlled by busulfan therapy.
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7
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Morris CM, Fitzgerald PH. Complexity of an apparently simple variant Ph translocation in chronic myeloid leukemia. Leuk Res 1987; 11:163-9. [PMID: 3469484 DOI: 10.1016/0145-2126(87)90022-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient with chronic myeloid leukemia (CML) presented with an apparently simple Ph translocation t(19;22)(q13;q11). In-situ hybridization revealed movement of the c-abl oncogene from a cytogenetically normal chromosome 9 to the Ph. Bcr-3' and c-sis probes hybridized to distal 1p and not to the 19q+ chromosome as expected from the cytogenetic findings. We concluded that this patient had a complex translocation involving four chromosomes: t(1;9;19;22)(p36;q34;q13;q11).
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8
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Abstract
The incidence of breakpoints in CML patients with variant translocations was investigated. There was no relationship between the length of various chromosomes with breakpoint frequency. However, a significantly higher (p less than 0.05) incidence of breaks were seen on the long arms as compared to the short arms due mainly to the involvement of 9q and 22q in these translocations. Chromosome 17 showed a significantly (p less than 0.005) higher involvement in these translocations, however only when 9q34-qter was not cytogenetically involved. A total of 683 breaks were found in 225 cases. 362 of these were located at c-abl and c-sis, while 110 were at other oncogenetic sites. The prognostic and hematologic features of patients with variant translocations are not significantly different from those of CML cases with the typical 9q;22q translocation. Some of these complex translocation, where the breakpoints are correlated with oncogenetic sites, are further discussed in molecular terms.
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Affiliation(s)
- R S Verma
- Division of Genetics, Long Island College Hospital, Brooklyn, NY 11201
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9
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Maserati E, Pasquali F, Peretti D. Different break-points in Philadelphia chromosome variant translocations and in constitutional and sporadic translocations. Ann Hum Genet 1986; 50:153-62. [PMID: 3435044 DOI: 10.1111/j.1469-1809.1986.tb01034.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three different samples of translocations were considered in an attempt to identify those chromosomal bands preferentially involved in variant Philadelphia chromosome (Ph1) translocations, and to compare them with bands preferentially broken in constitutional and sporadic translocations. The first sample included 204 cases of variant Ph1 translocations with 221 identified break-points (bp), the second consisted of 106 cases of non-Robertsonian constitutional translocations with 213 bp identified, and the third one of 185 bp identified in sporadic translocations found occasionally in single cells of subjects with normal karyotypes and without haematological disorders. A statistical analysis demonstrated that there are some bands preferentially broken in each of the samples, and this with a high level of significance (P less than 0.001). The analysis of the distributions of the chi 2 components permitted us to identify the 12 bands preferentially involved in variant Ph1 translocations and the 13 and 9 bands preferentially involved in constitutional and sporadic translocations, respectively. The comparison among the groups of preferential bp showed that the bands most involved in the three samples are different. Some theoretical problems related to the origin of the Ph1 chromosome are discussed.
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Affiliation(s)
- E Maserati
- Biologia Generale e Genetica Medica, Università di Pavia, Italy
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10
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Holden JJ, Simpson J, Ginsburg A, Smith A, Hughes P. Two apparent Philadelphia chromosomes arising from translocations with different chromosomes in a patient with CML: 46,XY,t(7;22)(p22;q11),t(9;22)(q34;q11). CANCER GENETICS AND CYTOGENETICS 1986; 21:297-302. [PMID: 3456823 DOI: 10.1016/0165-4608(86)90208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chromosome studies on bone marrow cells and unstimulated peripheral lymphocytes from a patient with chronic myelogenous leukemia revealed the presence in all cells of two apparent Philadelphia chromosomes: one resulting from the classical translocation with a chromosome #9, and the other arising from a translocation between chromosomes #22 and #7. There was no normal chromosome #22. Some of the cells also had an i(17q), indicative of blast crisis. Repeated chromosome studies at different times during the course of the disease revealed the evolution of additional karyotypic changes. All cells from later samples had an extra #8; some of these cells had a third Philadelphia chromosome, whereas, others had a second Y chromosome. Although a few normal cells were seen in PHA-stimulated lymphocyte cultures, indicating that the patient has a normal constitutional karyotype, most of the cells had a karyotype identical to that found in unstimulated cultures. This unusual karyotype, 46,XY,t(7;22)(p22;q11),t(9;22)(q34;q11), represents the first case in which two apparent Philadelphia chromosomes are present in the leukemic cells from a patient in the absence of a normal #22 chromosome.
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11
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Barbata G, Granata G, Bellanca F, Modica L, Carbone P. Complex translocation t(3;9;22) and paracentric inversion of chromosome 3 in blastic crisis of chronic myeloid leukemia. CANCER GENETICS AND CYTOGENETICS 1986; 20:305-9. [PMID: 3455869 DOI: 10.1016/0165-4608(86)90088-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a complex rearrangement observed in both the short and long arms of chromosome #3 in a patient with Ph-positive chronic myeloid leukemia in blastic crisis and without thrombopoietic abnormalities. The rearrangement consisted of a complex translocation, t(3;9;22)(p21;q34;q11), and a paracentric inversion of the long arm of the same chromosome #3 involved in the translocation. Involvement of chromosome #3 in complex translocations in chronic myeloid leukemia and the relationship between 3q anomalies and thrombopoietic diseases are discussed.
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MESH Headings
- Chromosome Inversion
- Chromosomes, Human, 21-22 and Y
- Chromosomes, Human, 4-5
- Chromosomes, Human, 6-12 and X
- Humans
- Karyotyping
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Translocation, Genetic
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12
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London B, Pinkerton PH, Senn JS. A new translocation in chronic myeloid leukemia--t(4;9;22)--resulting in a masked Philadelphia chromosome. CANCER GENETICS AND CYTOGENETICS 1986; 20:5-9. [PMID: 3455862 DOI: 10.1016/0165-4608(86)90102-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient with chronic myeloid leukemia is described in whom a novel complex translocation was found among chromosomes #4, #9, and #22, resulting in a "masked" Philadelphia chromosome. The breakpoint in chromosome #4 (band q21) is in the same region as the breakpoint seen in the t(4;11), which is associated with some forms of acute leukemia.
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13
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Sessarego M, Ajmar F, Bianchi Scarrà GL, Ravazzolo R, Garré C, Boccaccio P. Unusual Ph translocations in CML: four new cases. CANCER GENETICS AND CYTOGENETICS 1985; 15:199-207. [PMID: 3855686 DOI: 10.1016/0165-4608(85)90163-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Four variants of the Ph chromosome translocation in chronic myelogenous leukemia (CML) patients are described. Two had an unusual simple translocation involving chromosomes #7 and #17. In two cases, the translocation, aside from involving #9 and #22, involved a third chromosome, chromosome #6 and chromosome #11, respectively. Three cases showed also karyotypic evolution during the blastic phase of the disease: in two cases, a new reciprocal translocation was found that involved a chromosome #9 at band q34. The clinical and cytogenetic significance of these results is briefly discussed.
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14
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15
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Hagemeijer A, Bartram CR, Smit EM, van Agthoven AJ, Bootsma D. Is the chromosomal region 9q34 always involved in variants of the Ph1 translocation? CANCER GENETICS AND CYTOGENETICS 1984; 13:1-16. [PMID: 6467178 DOI: 10.1016/0165-4608(84)90083-9] [Citation(s) in RCA: 147] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Six variants of the Ph1 translocation are described. The clinical diagnoses were chronic myeloid leukemia (CML) in 5 cases (patients 1-5) and acute lymphocytic leukemia (ALL) in patient 6. Three Ph1 variants were clear complex translocations, involving chromosomes #9, #22, and a third chromosome, i.e., #16, #11, or #14. The other three Ph1 variants appeared as "simple" translocations between chromosome #22 and chromosome #19, #4, or #12 when G- or Q-banding were used. When studied with high resolution R-banding, a small deletion of the terminal part of one chromosome #9 was visible, strongly suggesting that these variants were also complex translocations, i.e., t(9;19;22)(q34;p13;q11),t(4;9;22) (p16;q34;q11), and t(9;12;22)(q34;p13;q11). In the latter two cases, using in situ hybridization techniques, we demonstrated the presence of c-abl sequences on the Ph1 chromosome. This proved the involvement of 9q34 in these two variants. Our proposal is that most, and probably all, variants of Ph1 are complex translocations involving part of 9q34 and that the conjunction of a specific region of 22q11 with a specific segment of 9q34 (carrying the c-abl protooncogene) is essential for the development of Ph1 + CML.
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16
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Prakash O, Yunis JJ. High resolution chromosomes of the t(9;22) positive leukemias. CANCER GENETICS AND CYTOGENETICS 1984; 11:361-7. [PMID: 6584200 DOI: 10.1016/0165-4608(84)90015-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A combined bromodeoxyuridine (BrdU) and actinomycin D (AMD) treatment of methotrexate (MTX) synchronized bone marrow cells from four patients with chronic myelogenous leukemia (CML), and two each with acute lymphocytic (ALL) and acute nonlymphocytic (ANLL) leukemia were used to define the breakpoints involved in the t(9;22) found in subgroups of these three disorders. An additional 20 patients with CML were studied with the MTX technique alone. All cases showed the same breakpoints at subbands 9q34.1 and 22q11.2. In CML, it was possible to further define the breakpoint of chromosome 22 to subband q11.21.
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17
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Lewis JP, Watson-Williams EJ, Lazerson J, Jenks HM. Chronic myelogenous leukemia and genetic events at 9q34. Hematol Oncol 1983; 1:269-74. [PMID: 6376316 DOI: 10.1002/hon.2900010309] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Assessment of cytogenetic patterns associated with chronic myelogenous leukemia (CML) suggests that genetic events at band q34 of chromosome nine are critical in the conversion of benign to malignant hematopoiesis. A break at this band is identified in almost all cases of Philadelphia chromosome (Ph1) positive CML, is also noted in some cases of Ph1 negative CML and cannot be excluded in the remaining cases. The human cellular homolog of the Abelson retrovirus oncogene (c-abl) is situated at band 9q34 and is translocated with the genetic sequences distal to the break point at this site in Ph1 positive disease. This oncogene has been shown experimentally to transform pre-B cells and it is expressed in primitive cells of the granulocytic series which are involved in CML. Although the break in CML chromosomes at 9q34 and the location of c-abl at 9q34 could be unrelated, it seems more likely that the two genetic events are associated with evolution of malignant hematopoiesis of man.
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18
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Sessarego M, Pasquali F, Bianchi Scarrà GL, Ajmar F. Masked Philadelphia chromosome caused by translocation (9;11;22). CANCER GENETICS AND CYTOGENETICS 1983; 8:319-23. [PMID: 6572552 DOI: 10.1016/0165-4608(83)90074-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In a patient with chronic myelocytic leukemia (CML), chromosome analysis revealed a translocation involving chromosomes No. 9, 11, and 22, with three break points, thus giving origin to a so-called "masked" Philadelphia chromosome (Ph1). A review of similar cases reported in the literature indicates that a masked Ph1 is very rare, that the chromosomes involved vary from case to case, and that in most cases the pattern of the rearrangement is quite different from that of two- and three-chromosome variant Ph1 translocations.
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19
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Casalone R, Bernasconi P, Pasquali F. Involvement of chromosome No. 20 in a complex Ph1 translocation. CANCER GENETICS AND CYTOGENETICS 1983; 8:181-2. [PMID: 6572091 DOI: 10.1016/0165-4608(83)90048-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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20
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Tomiyasu T, Sasaki M, Kondo K, Okada M. Chromosome banding studies in 106 cases of chronic myelogenous leukemia. JINRUI IDENGAKU ZASSHI. THE JAPANESE JOURNAL OF HUMAN GENETICS 1982; 27:243-58. [PMID: 6962308 DOI: 10.1007/bf01901320] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Oshimura M, Ohyashiki K, Terada H, Takaku F, Tonomura A. Variant Ph1 translocations in CML and their incidence, including two cases with sequential lymphoid and myeloid crises. CANCER GENETICS AND CYTOGENETICS 1982; 5:187-201. [PMID: 6950809 DOI: 10.1016/0165-4608(82)90025-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A serial cytogenetic study of 110 cases of chronic myelogenous leukemia (CML) has been performed with G- and/or Q-banding techniques with the following results. (1) Seven out of the 110 cases were karyotypically normal. (2) A variant Ph1 translocation was observed in three cases. In one case, the leukemic cells contained two reciprocal translocations, i.e., a t(3;9) (q21;q34) and a t(17;22)(q21;q11); therefore, a Ph1 chromosome was masked by a translocation of the deleted material from the 17q onto the band q11 of the long arm of a chromosome No. 22. In the second case, a variant Ph1 translocation involved chromosomes No. 9, 20, and 22, resulting in a karyotype interpreted as 46,XX,t(9q+;20q+;22q-); in this rearrangement, one of the segments, i.e., 9q31 or 9q33, seemed to be interstitially deleted and inserted into the interstitial region (q11) of a chromosome No. 20 and the 22q11 leads to qter was translocated onto the 9q. This is the first case in which chromosome No. 20 was involved in a variant Ph1 translocation. In the third case, the karyotype of leukemic cells was interpreted as 46,XX,t(5;9;22)(q13;q34;q11). (3) The frequency of Ph1-negative CML and that of Ph1-positive CML with various types of Ph1 translocation from 15 studies reported as series of 25 or more cases, including the present study, have been tabulated. The incidence of a variant Ph1 translocation was 4.1% (42/1027 cases of Ph1-positive CML); of the 42, 13 were of a simple type and 29 of a complex type. (4) In one case of the present study, a masked Ph1 by a translocation of material onto the short arm of the 22q- was observed in the blastic crisis but not in the chronic phase. From the present study and a review of the published cases, it appears that the incidence of such a "masked" Ph1, which cannot be detected by conventional Giemsa staining, is less than 0.6% in CML cases. (5) The first and the second cases with a variant Ph1 translocation mentioned above developed a myeloid blastic crisis after the induction of remission of a lymphoid blastic crisis. For the present, it is unclear whether the occurrence of such blast cells in the two cases and the cytogenetic findings are coincidental. However, the evidence supports the notion of "lymphoid-myeloid" multipotentiality of certain leukemic cells.
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MESH Headings
- Adult
- Bone Marrow Cells
- Chromosome Banding
- Chromosomes, Human, 19-20/ultrastructure
- Chromosomes, Human, 21-22 and Y/ultrastructure
- Chromosomes, Human, 4-5/ultrastructure
- Chromosomes, Human, 6-12 and X/ultrastructure
- Female
- Humans
- Karyotyping
- Leukemia, Myeloid/genetics
- Male
- Middle Aged
- Translocation, Genetic
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22
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Brusamolino E, Bertazzoni U, Isernia P, Ginelli E, Scovassi AI, Zurlo MG, Plevani P, Sacchi N, Bernasconi C. Clinical relevance of terminal transferase and adenosine deaminase in leukemia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1982; 145:279-303. [PMID: 7051780 DOI: 10.1007/978-1-4684-8929-3_24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Terminal Transferase (TdT), Adenosine Deaminase (ADA), immunological membrane markers, cytochemical reactivity and cytogenetics were analyzed in 226 patients with ALL, AUL and AML, in 70 patients with CML and in 3 cases of Ph' positive acute leukemia presenting as ALL. TdT was tested in peripheral blood and bone marrow with both the biochemical and immunofluorescence (IF) methods, and ADA was determined biochemically only in peripheral blood cells. By using conventional cytochemistry, cell surface markers determinations, TdT and ADA analysis, three distinct groups are recognized in ALL at presentation: T-ALL with TdT+ and very high ADA values; non-T, non-B ALL with TdT+ and intermediate levels of ADA; B-ALL with TdT absence and low levels of ADA. Clinical presentation and responses to therapy in adult and children ALL were correlated to TdT determinations. The median survivals in adults, calculated for TdT+ and TdT- groups, were 14.2 and 5.6 months, respectively. TdT and ADA were determined in ALL during remission. The wide fluctuation observed for TdT IF and ADA values prevented a reliable monitoring of remissions. At relapse, TdT and ADA values were similar to those found for ALL at presentation; TdT IF determinations were diagnostic in cases showing CNS involvement as the only localization. Forty per cent of AUL and 11% of AML cases were positive for TdT; the medians of ADA values of the TdT+ cases in both AML and AUL were several times higher than those obtained in the TdT- group. While TdT positivity and high ADA had a favorable prognostic value in AUL, similar conclusions can not be drawn at the moment for AML. In chronic phase of CML, TdT was strictly negative and ADA values were increased over the control line only in cases showing initial signs of transformation. In acute phase, the cases positive for TdT (32%) presented a significantly higher ADA activity than the TdT negative ones. The actuarial survival curves for the TdT+ and TdT- groups differ significantly, presenting median survivals from onset of phase of 11 and 4.8 months respectively. The three cases of Ph' positive ALL were all TdT+, presented high ADA values and entered chronic phase of CML after therapy.
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Lessard M, Duval S, Fritz A. Unusual translocation and chronic myelocytic leukemia: "masked" Philadelphia chromosome (Ph 1). CANCER GENETICS AND CYTOGENETICS 1981; 4:237-44. [PMID: 6947859 DOI: 10.1016/0165-4608(81)90017-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An unusual Ph 1 translocation in a woman, 65 years old, with chronic myelocytic leukemia is reported. Cytogenetic analysis performed on 150 mitoses examined with Q-, R-, and C-banding revealed evidence for an unusual translocation involving the insertion of a segment of chromosome #9 into chromosome #22, thus masking the presence of a Ph 1. The anomaly can best be described as 46, XX, ins(22;9) (q11;q22 to 34).
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24
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Fleischman EW, Prigogina EL, Volkova MA, Frenkel MA, Zakhartchenko NA, Konstantinova LN, Puchkova GP, Balakirev SA. Correlations between the clinical course, characteristics of blast cells, and karyotype patterns in chronic myeloid leukemia. Hum Genet 1981; 58:285-93. [PMID: 6948765 DOI: 10.1007/bf00294925] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Results of chromosome studies of blood and bone marrow cells from 101 patients with Ph1 positive chronic myeloid leukemia (CML) confirm the assumptions that clinical and morphologic manifestations of the disease correlate with karyotype peculiarities of leukemia cells. Several variants of the clinical course of CML may be distinguished. One is the variant with a short chronic phase and a comparatively long terminal phase. In blastic crisis the blast cells are peroxidase negative and do not possess cytoplasmic inclusions. Acute transformation occurs without any additional chromosome damage. The second, more common form is less severe because of longer chronic phase but it has a short and grave acute stage. The blast cells present definite signs of myeloid differentiation, they have basophilic or neutrophilic cytoplasmic granules and are peroxidase positive. Marker i(17q) often combined with trisomy 8 is a characteristic chromosome abnormality in the terminal stage of this variant. The third type has an extremely long chronic phase but ends in a rapidly progressing severe and resistant to therapy "lymphoid" blastic crisis. Blast cells have typical "lymphoid" morphology, they are peroxidase negative and contain granular PAS positive substance. Various additional chromosome changes appear in the terminal stage. Future studies of a larger series of patients may possibly reveal more CML variants.
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25
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Pasquali F, Casalone R. Rearrangement of three chromosomes (nos. 2,8, and 21) in acute myeloblastic leukemia. Evidence for more than one specific event. CANCER GENETICS AND CYTOGENETICS 1981; 3:335-9. [PMID: 6942910 DOI: 10.1016/0165-4608(81)90042-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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26
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Borgström GH. New types of unusual and complex Philadelphia chromosome (Ph1) translocations in chronic myeloid leukemia. CANCER GENETICS AND CYTOGENETICS 1981; 3:19-31. [PMID: 6944149 DOI: 10.1016/0165-4608(81)90052-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nine cases of Philadelphia chromosome-positive chronic myeloid leukemia with an aberrant translocation are reported. In three cases an unusual translocation was found, the recipient chromosome being Nos. 14, 17, and 18, respectively. In six cases the translocation involved a third chromosome in addition to Nos. 9 and 22: there were two cases involving chromosome No. 1, two involving chromosome No. 14, one involving chromosome No. 3, and one involving chromosome No. 12. The clinical significance of the aberrant translocations and the translocation mechanism is discussed.
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MESH Headings
- Adult
- Aged
- Bone Marrow/pathology
- Chromosomes, Human, 13-15
- Chromosomes, Human, 16-18
- Chromosomes, Human, 21-22 and Y
- Chromosomes, Human, 6-12 and X
- Female
- Humans
- Karyotyping
- Leukemia, Myeloid/genetics
- Male
- Middle Aged
- Translocation, Genetic
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Sessarego M, Bianchi Scarrà GL, Ajmar F, Salvidio E. Karyotype evolution in a case of chronic myelogenous leukemia with an unusual Philadelphia chromosome translocation, t(4;22), and an additional translocation, t(3;5). CANCER GENETICS AND CYTOGENETICS 1981; 3:47-51. [PMID: 6944151 DOI: 10.1016/0165-4608(81)90055-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A patient with chronic myelogenous leukemia was found, at the time of diagnosis, to have an unusual Philadelphia chromosome translocation, t(4;22) (q35;q11) and an additional previously unreported translocation, t(3;5) (q27;q22). The blastic crisis, which occurred after 14 months, was characterized by the appearance of i(17q). Ten months later, two different hyperdiploid cell lines with 50 chromosomes were found in about 20% of the metaphases examined.
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Kessous A, Colombies P, Sudries M, Bourrouillou G, Pris J, Clement D. Complex Ph1 translocation in chronic myeloid leukemia. ACTA ACUST UNITED AC 1980. [DOI: 10.1016/0165-4608(80)90064-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Carbonell F, Kratt E, Neuhaus K. Complex translocations between chromosomes #6, #9, #22, and #11 in a patient with chronic myelocytic leukemia: 46,XX,t(6;9;22;11)(p21;q34;q11;q13). ACTA ACUST UNITED AC 1980. [DOI: 10.1016/0165-4608(80)90057-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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