Philadelphia chromosome-positive acute myeloid leukemia with tetraploidy

The prognostic implications of tetraploidy/near-Tetraploidy in acute myeloid leukemia: a case series and systematic review of the literature

The prognostic significance and optimal management of tetraploidy/near-tetraploidy acute myeloid leukemia (T/NT AML) remains unclear given its limited data. This is especially true after factoring in additional chromosomal alterations, which carry their own prognostic weight. Here, we analyze 128 cases of T/NT in AML from the literature along with two additional cases, which is the largest review of this subject to date. Based on our retrospective analysis, we found that regardless of the risk status attributed to cytogenetics, the prognosis of tetraploid or near-tetraploid AML is dismal and should be incorporated within the unfavorable risk group. Complete remission is paramount to survival in this population. Specific induction protocols for high-risk AML appear to have higher rates of complete remission in the T/NT AML population. Moreover, longer overall survival can be achieved with chemotherapy followed by allogeneic stem cell transplantation at first complete remission.

[Clinical and laboratory characteristics of 12 Ph/BCR-ABL positive acute myeloid leukemia patients]

目的

探讨有利于Ph染色体和（或）BCR-ABL融合基因阳性急性髓系白血病（Ph/BCRABL⁺ AML）诊断的临床和实验室特征。

方法

收集2006年2月至2013年12月收治的12例Ph/BCR-ABL⁺ AML患者资料，以典型慢性髓性白血病急髓变（CML-MBC）患者为对照组，回顾性分析两者临床及实验室特征，并随访生存情况。

结果

12例患者中位年龄27.5岁，无或轻度脾脏肿大者10例（83.3%），FAB分型以M₂和M₄为主，中位外周血和骨髓嗜碱粒细胞比例、巨核细胞数低于典型CML-MBC患者。免疫表型均为髓系表达，表达CD34者8例（66.7%）。11例患者检测到t(9;22)，伴附加染色体异常5例（45.5%），其中1例为inv(16）。12例患者均检测到BCR-ABL融合基因，e1a2型3例（25.0%），余为b2a2/b3a2型，其中1例伴有CBFβ-MYH11表达。6例受检患者中2例存在AML常见突变，其中CEBPA突变1例，FLT3-TKD突变1例。诱导治疗完全缓解(CR) 7例（58.3%），7例接受化疗联合酪氨酸激酶抑制剂（TKI）者6例CR，3例接受单独化疗者1例CR。总体中位生存期16.5个月，异基因造血干细胞移植（allo-HSCT）组为33.5个月，高于非移植组（5.5个月）。

结论

e1a2型融合基因、与AML常见融合基因共表达、存在AML常见突变有利于Ph/BCR-ABL⁺ AML诊断；此类患者诱导缓解率低，生存期短，化疗联合TKI获得缓解后尽早行allo-HSCT是改善其生存的唯一有效途径。

t(14;22)(q32;q11) in non-Hodgkin lymphoma and myeloid leukaemia: molecular cytogenetic investigations

Two non-Hodgkin lymphomas (NHL), one chronic lymphocytic leukaemia/small lymphocytic lymphoma and one diffuse large B-cell lymphoma and three cases of myeloid leukaemia, two chronic (CML) and one acute (AML), showed, by G-banding analysis, apparently identical chromosomal translocations t(14;22)(q32;q11), in three of the cases as the sole abnormality. Fluorescence in situ hybridisation (FISH) analysis with locus-specific probes for ABL at 9q34 [bacterial artificial chromosomes (BACs) 835J22 and 1132H12], IGH at 14q32 [P1 artificial chromosome (PAC) 998D24] and IGL (PAC 1019H10) and BCR (BAC 74M14) at 22q11, as well as multicolour in situ hybridisation (M-FISH) analyses were performed. A three-way variant translocation of the classical t(9;22)(q34;q11), t(9;22;14)(q34;q11;q32), involving both BCR and ABL, was unravelled by the molecular cytogenetic investigations in the three myeloid leukaemia cases; a similar variant translocation has previously been reported in seven CML. The two cases of NHL (one NHL with a similar 14;22-translocation has been reported previously) had no involvement of BCR or ABL, but instead the IGH and IGL genes were shown to be juxtaposed by the t(14;22)(q32;q11). How such a rearrangement with recombination of IGH and IGL might elicit a pathogenetic effect is completely unknown.