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Frazzetto S, Gullo L, Sapuppo G, Fazio M, Lo Faro C, Giunta G, Caravotta I, Mauro E, Parisi MS, Triolo AM, Parrinello NL, Consoli ML, També L, Cambria D, Marino S, Scuderi G, Di Raimondo F. Three-Way Translocation t(12;15;17) (p13;q24;q21) Found in Acute Promyelocytic Leukemia with Basophilic Differentiation. Hematol Rep 2024; 16:367-374. [PMID: 38921185 PMCID: PMC11203485 DOI: 10.3390/hematolrep16020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Acute promyelocytic leukemia is a rare form of acute myeloid leukemia in which immature promyelocytes abnormally proliferate in the bone marrow. In most cases, the disease is characterised by the translocation t(15;17) (q24;q21), which causes the formation of PML::RARA, an oncogenic fusion protein responsible for blocking myeloid differentiation and survival advantage. Here, we present a case of acute promyelocytic leukemia with two unusual features: basophilic differentiation and a three-way translocation involving chromosomes 12, 15 and 17. In the few cases reported, basophilic differentiation was associated with a poor prognosis. In contrast, our patient responded promptly to the standard treatment with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) and obtained complete remission. To our knowledge, this is the first report of basophilic acute promyelocytic leukemia with the three-way translocation t(12;17;15) (p13; q24;q21).
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Affiliation(s)
- Sara Frazzetto
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Lara Gullo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Gabriele Sapuppo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Manlio Fazio
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Cristina Lo Faro
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Giuliana Giunta
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Ignazio Caravotta
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Elisa Mauro
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Marina Silvia Parisi
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Anna Maria Triolo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Nunziatina Laura Parrinello
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Maria Letizia Consoli
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Loredana També
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Daniela Cambria
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Sara Marino
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Grazia Scuderi
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
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Guarnera L, Ottone T, Fabiani E, Divona M, Savi A, Travaglini S, Falconi G, Panetta P, Rapanotti MC, Voso MT. Atypical Rearrangements in APL-Like Acute Myeloid Leukemias: Molecular Characterization and Prognosis. Front Oncol 2022; 12:871590. [PMID: 35494081 PMCID: PMC9039303 DOI: 10.3389/fonc.2022.871590] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023] Open
Abstract
Acute promyelocytic leukemia (APL) accounts for 10–15% of newly diagnosed acute myeloid leukemias (AML) and is typically caused by the fusion of promyelocytic leukemia with retinoic acid receptor α (RARA) gene. The prognosis is excellent, thanks to the all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) combination therapy. A small percentage of APLs (around 2%) is caused by atypical transcripts, most of which involve RARA or other members of retinoic acid receptors (RARB or RARG). The diagnosis of these forms is difficult, and clinical management is still a challenge for the physician due to variable response rates to ATRA and ATO. Herein we review variant APL cases reported in literature, including genetic landscape, incidence of coagulopathy and differentiation syndrome, frequent causes of morbidity and mortality in these patients, sensitivity to ATRA, ATO, and chemotherapy, and outcome. We also focus on non-RAR rearrangements, complex rearrangements (involving more than two chromosomes), and NPM1-mutated AML, an entity that can, in some cases, morphologically mimic APL.
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Affiliation(s)
- Luca Guarnera
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Santa Lucia Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuro-Oncohematology, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Department of Biomedicine and Prevention, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Mariadomenica Divona
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Arianna Savi
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Serena Travaglini
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Paola Panetta
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Maria Cristina Rapanotti
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Santa Lucia Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuro-Oncohematology, Rome, Italy
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Jiang XW, Chen SZ, Zhu XY, Xu XX, Liu Y. Development and validation of a droplet digital PCR assay for the evaluation of PML-RARα fusion transcripts in acute promyelocytic leukemia. Mol Cell Probes 2020; 53:101617. [PMID: 32585184 DOI: 10.1016/j.mcp.2020.101617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Abstract
Acute promyelocytic leukemia (APL) is an aggressive disease that requires prompt treatment. Promyelocytic leukemia protein-retinoic acid receptor α (PML-RARα) fusion genes resulting from reciprocal translocation are considered a molecular basis for diagnosing APL. Moreover, PML-RARα fusion gene testing is an essential tool for monitoring the response to therapy via minimal residual disease and providing a diagnosis before rapid disease progression in APL. The present study developed a novel droplet digital PCR (ddPCR) assay to rapidly detect two PML-RARα variants (bcr1 and bcr3) and compared its limit of detection (LOD) with quantitative PCR (qPCR). It was demonstrated that the LOD of ddPCR for PML-RARα reached 0.001%, and the evaluation of high copy number samples of PML-RARα by ddPCR correlated well with qPCR. Furthermore, clinical sample testing with ddPCR found that 34 and 24% samples were bcr-1-positive and bcr3-positive, respectively. However, according to qPCR, 30% of the samples were bcr1-positive and 20% were bcr3-positive. In addition, the concordance rate between ddPCR and qPCR reaction was 86%. While monitoring minimal residual disease, the PML-RARα mutation rate of three patients who recovered well decreased to 0.34%. However, one patient who was bcr3-positive and relapsed had a mutation rate of 13% while in remission, indicating that the bcr3 isoform may be an adverse prognostic factor affecting recovery. Therefore, the present results suggested that this novel ddPCR assay may be useful for monitoring and evaluating the treatment effects and prognosis of APL.
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Affiliation(s)
- Xi-Wen Jiang
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China.
| | - Si-Ze Chen
- Central Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China; The Precise Therapy Engineering Technology Research Cente of Guangdong Province for Esophageal Cancer, Guangzhou, 510080, China
| | - Xiao-Ya Zhu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China
| | - Xiao-Xie Xu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China
| | - Yue Liu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China
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Lv L, Yang L, Cui H, Ma T. A complex translocation (1;17;15) with spliced short-type PML-RARA fusion transcripts in acute promyelocytic leukemia: A case report. Exp Ther Med 2018; 17:1360-1366. [PMID: 30680014 PMCID: PMC6327484 DOI: 10.3892/etm.2018.7091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/26/2018] [Indexed: 11/08/2022] Open
Abstract
The promyelocytic leukemia (PML)-retinoic acid receptor α (RARA) fusion is hypothesized to serve a vital role in the pathogenesis of acute promyelocytic leukemia (APL), which results from a reciprocal translocation between chromosomes 15 and 17, t(15;17)(q24;q21). A minority of APL cases lack the classical t(15;17) and have been identified to have cryptic or masked t(15;17) or complex translocations. The present study reports on a case of a 37-year-old male with APL harboring a complex three-way translocation t(1;17;15)(q21;q21;q24). This karyotypic interpretation was further confirmed by fluorescence in situ hybridization, and 98% of the bone marrow cells analyzed were positive for the PML-RARA fusion gene. After combined treatment with all-trans retinoic acid and arsenic trioxide, the patient achieved complete remission with no recurrence for 3 years to date. To the best of our knowledge, the present study is the first to report on the novel variant of t(15;17) involving the breakpoint 1q21.
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Affiliation(s)
- Lili Lv
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Honghua Cui
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Tonghui Ma
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
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Baba S, Pandith A, Shah Z, Baba R. Pathogenetic implication of fusion genes in acute promyelocytic leukemia and their diagnostic utility. Clin Genet 2018; 95:41-52. [DOI: 10.1111/cge.13372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 01/16/2023]
Affiliation(s)
- S.M. Baba
- Department of Immunology and Molecular MedicineSher‐I‐Kashmir Institute of Medical Sciences Srinagar India
| | - A.A. Pandith
- Advanced Centre for Human GeneticsSher‐I‐Kashmir Institute of Medical Sciences Srinagar India
| | - Z.A. Shah
- Department of Immunology and Molecular MedicineSher‐I‐Kashmir Institute of Medical Sciences Srinagar India
| | - R.A. Baba
- Department of Immunology and Molecular MedicineSher‐I‐Kashmir Institute of Medical Sciences Srinagar India
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Adams J, Nassiri M. Acute Promyelocytic Leukemia: A Review and Discussion of Variant Translocations. Arch Pathol Lab Med 2016; 139:1308-13. [PMID: 26414475 DOI: 10.5858/arpa.2013-0345-rs] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The majority of patients with acute promyelocytic leukemia (APL) manifest the t(15;17)(q24.1;q21.2) translocation; however, a minor but significant proportion of patients with APL harbor complex, cryptic, or variant translocations, which typically involve RARA. With the exception of ZBTB16/RARA, these variants have similar morphologic and immunophenotypic features as classic APL. Study of the variant forms of APL not only gives insight into the pathogenesis of APL but also allows us to understand the mechanism of retinoid therapy. It is important to identify these cryptic and variant translocations because certain variants, including ZBTB16/RARA and STAT5B/RARA, are resistant to treatment with all-trans retinoic acid, arsenic trioxide, and anthracyclines.
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Affiliation(s)
- Julia Adams
- From the Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis
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Shahjahani M, Khodadi E, Seghatoleslami M, Asl JM, Golchin N, Zaieri ZD, Saki N. Rare Cytogenetic Abnormalities and Alteration of microRNAs in Acute Myeloid Leukemia and Response to Therapy. Oncol Rev 2015; 9:261. [PMID: 26779308 PMCID: PMC4698590 DOI: 10.4081/oncol.2015.261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/06/2014] [Accepted: 11/29/2014] [Indexed: 12/13/2022] Open
Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia in adults, which is heterogeneous in terms of morphological, cytogenetic and clinical features. Cytogenetic abnormalities, including karyotype aberrations, gene mutations and gene expression abnormalities are the most important diagnostic tools in diagnosis, classification and prognosis in acute myeloid leukemias. Based on World Health Organization (WHO) classification, acute myeloid leukemias can be divided to four groups. Due to the heterogeneous nature of AML and since most therapeutic protocols in AML are based on genetic alterations, gathering further information in the field of rare disorders as well as common cytogenetic abnormalities would be helpful in determining the prognosis and treatment in this group of diseases. Recently, the role of microRNAs (miRNAs) in both normal hematopoiesis and myeloid leukemic cell differentiation in myeloid lineage has been specified. miRNAs can be used instead of genes for AML diagnosis and classification in the future, and can also play a decisive role in the evaluation of relapse as well as response to treatment in the patients. Therefore, their use in clinical trials can affect treatment protocols and play a role in therapeutic strategies for these patients. In this review, we have examined rare cytogenetic abnormalities in different groups of acute myeloid leukemias according to WHO classification, and the role of miRNA expression in classification, diagnosis and response to treatment of these disorders has also been dealt with.
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Affiliation(s)
- Mohammad Shahjahani
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elahe Khodadi
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Seghatoleslami
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Mohammadi Asl
- Department of Medical Genetics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Golchin
- Noor Clinical & Specialty Laboratory, Ahvaz, Iran
| | - Zeynab Deris Zaieri
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmaldin Saki
- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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