Trisomy 4 in a case of acute biphenotypic leukemia

Acute leukemia of ambiguous lineage with trisomy 4 as the sole cytogenetic abnormality: A case report and literature review

We describe a patient with acute leukemia of ambiguous lineage who had trisomy 4 as the sole cytogenetic abnormality. Clinical, pathological, immunophenotypic and molecular features are presented and compared with the previous 4 published cases. Over expression of c-kit, which is localized to chromosome 4, was documented on the leukemic blasts. Prognosis seems to be poor. Treatment with acute lymphoblastic leukemia like regimens seems to be superior compared to acute myeloid leukemia like regimens and allogeneic stem cell transplant is recommended after achieving remission.

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Acute leukemia of ambiguous lineage with trisomy 4 as the sole abnormality is a rare disease.

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Clinical and pathological details of a case are presented and compared with prior 4 published cases.

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Over expression of c-kit, localized to chromosome 4, may play a pathogenic role in this disease.

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Prognosis seems to be poor.

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Treatment with ALL like regimens seems to be superior compared to AML like regimens.

Trisomy 4 associated with double minute chromosomes and MYC amplification in acute myeloblastic leukemia

A case of de novo acute myeloblastic leukemia (AML) M2, with trisomy 4 and double minute (dmin) chromosomes is reported. Amplification of the MYC gene ascertained by FISH was associated with dmin. A review of the literature of trisomy 4-dmin-associated AML shows that this entity preferentially occurs in elderly women and is not always associated with previously identified exposition to mutagens.

Trisomy 4 as the sole cytogenetic abnormality in a patient with T-cell acute lymphoblastic leukemia

Trisomies as sole cytogenetic abnormalities are extremely rare in acute lymphoblastic leukemia (ALL). We describe here the clinical features and immunophenotyping, cytogenetic, and fluorescence in situ hybridization (FISH) findings in a T-cell ALL patient with trisomy 4 as the sole cytogenetic abnormality. The leukemic clone was positive for CD2, CD7, CD34, and terminal deoxynucleotidyl transferase (TdT); CD13 was weakly expressed. Data on the tracking of the leukemic clone with immunophenotyping, cytogenetic, and FISH studies are discussed. The present case is compared with the three previous reported cases of trisomy 4 in ALL. Due to the rarity of this cytogenetic abnormality, its prognostic significance in ALL remains unclear.

Trisomy 4 as the sole karyotypic abnormality in a case of acute biphenotypic leukemia with T-lineage markers in minimally differentiated acute myelocytic leukemia

We report an unusual case of acute biphenotypic leukemia with trisomy 4. A 22-year-old woman presented with acute leukemia characterized by the presence of two cell populations (prothymocytic and myeloblastic). The leukemic cells were resistant to standard induction chemotherapy and were cleared from the bone marrow only after a salvage chemotherapy regimen. To our knowledge, this is the fourth reported case of acute biphenotypic leukemia with trisomy 4 and perhaps the first case with T-lineage markers and acute myelocytic leukemia.

[Chromosomal abnormalities in acute myeloid leukaemias]

Cytogenetic studies of acute myeloid leukaemias reveal non-random chromosomal abnormalities in 50-70% of karyotypes. Some are correlated with morphological and immunological parameters and constitute a prognostic factor independent of the other factors of risk: favourable for acute leukaemias myeloid with translocations t(8;21), t(15;17) and inversion or translocation of the chromosome 16, inv(16)/t(16;16), poor with deletion of the long arm of chromosome 5 del(5q), rearrangement of the 11q23 region and complex karyotypes. The distribution of the anomalies depends on the age: 11q23 and t(8;21) more frequent for the child, del(5q) and complex anomalies more frequent for the adult. The karyotypes are essential for the diagnosis, the follow-up of the patients and the evaluation of the relapse. It plays a fundamental part in the detection of new genes and their partners implied in the leucemogenese. The knowledge of their function is essential to open new therapeutic ways.

Trisomy 4 as the sole karyotypic anomaly in acute biphenotypic leukemia with B lineage markers and in acute minimally differentiated myeloid leukemia (M0)

Trisomy 4 is a recently defined chromosomal aberration in acute leukemia. The first reports suggested that this cytogenetic anomaly belongs to the M4 leukemia subtype of the FAB classification, but recent reports have described this alteration in a wider spectrum of leukemia subtypes. Here we report two cases of trisomy 4 as the sole chromosome anomaly: one was observed in a patient with acute biphenotypic leukemia with B-lineage markers and the second in a patient diagnosed with acute minimally differentiated myeloid leukemia (M0) with myelodysplastic features. To our knowledge these are, respectively, the first and second reports of trisomy 4 as the sole chromosomal anomaly in these leukemia subtypes.

Is trisomy 4 a secondary chromosomal abnormality in acute myeloblastic leukemia?

Cytogenetic studies were carried out in a patient with acute monocytic leukemia (AML-M5) at diagnosis and in relapse. While no chromosome abnormality was detected initially, isolated trisomy 4 was found in relapse. The primary or secondary nature of trisomy 4 as the sole abnormality in AML is discussed.

Biphenotypic M0 acute myeloid leukemia with trisomy-4

We report here a rare case of biphenotypic M0 acute myeloid leukemia (AML) associated with trisomy 4. The literature of trisomy 4 in acute leukemia was reviewed. M2 and M4 AML are the most common FAB subtypes associated with trisomy 4. The clinical course of this entity is generally comparable with other non-trisomy 4 cases of AML. Despite the speculation made when first described, no specific environmental toxin has been found to be associated with this entity. C-kit oncogene has been mapped to chromosome 4 recently, and the role of this proto-oncogene in leukemogenesis of trisomy 4 associated leukemia should be further investigated.

Trisomy 4 in a case of acute myelogenous leukemia accompanied by subcutaneous soft tissue tumors. Report of a case and review of the literature

We report a patient with acute myelogenous leukemia [AML, French-American-British classification (FAB) M2] with trisomy 4, who developed subcutaneous soft tissue tumors at the time leukemia was diagnosed. A review of the literature on AML with trisomy 4 suggests a relation between trisomy 4 and tumor formation of leukemic cells.

Trisomy 4 may occur in a broad range of hematologic malignancies

Trisomy 4 is an uncommon numerical chromosomal aberration in acute leukemia. We describe three cases of trisomy 4, occurring in two patients with acute myeloid leukemia (M1 and M5a) and in one patient with T-cell acute lymphoblastic leukemia. Our results suggest that trisomy 4 may occur in a broader range of hematologic and malignancies than previously described.

Trisomy 4 in acute nonlymphocytic leukemia: the first Brazilian case

We report the first South American case of acute nonlymphocytic leukemia, French-American-British (FAB) subtype M1, [1] with trisomy 4 as the sole chromosome abnormality. The patient denied exposure to toxic or carcinogenic substances.

Overexpression of c-kit in a leukemic cell population carrying a trisomy 4 and its relationship with the proliferative capacity

The expression of c-kit and its ligand, the stem cell factor (SCF), was studied in five cases of acute myeloid leukemia. One of these had a trisomy of chromosome 4, where the c-kit oncogene is located. In this case, the c-kit oncogene was overexpressed, but matched by a low expression of its ligand, SCF. The molecular evaluation of the growth rate by c-myc and the histone H3 expression indicated that the growth fraction of this cell population was very low. In one of the other leukemic cell populations studied, characterized by a low expression of c-kit and an elevated expression of the SCF, the growth fraction was also very low. Our results suggest that at least for some receptor oncogenes, the simple overexpression cannot be taken as an indication that the oncogene is involved in the deregulation of cell proliferation.

Trisomy 4 in acute myeloblastic and acute lymphoblastic leukemia

We report three cases of trisomy 4 in acute leukemia. This alteration was detected as the sole cytogenetic abnormality in a case of FAB M4 leukemia; it occurred in association with 5q deletion in a case of M1, and concomitant with Ph chromosome and trisomy 17 in a case of L2 leukemia. The latter case represents the fourth report of trisomy 4 in acute lymphoblastic leukemia.

Confirmation of a cryptic unbalanced translocation using whole chromosome fluorescence in situ hybridization

We report on a 7-year-old boy with minor anomalies, growth retardation, and developmental delay with an initial 46,XY,der(18)t(18;?)(q23;?) chromosome constitution. To determine the origin of the additional chromosome segment, several candidate regions were identified including 4q and 18q. Clinical comparison showed more similarities to individuals with partial dup(4q) than to those with a dup(18q). Whole chromosome fluorescence in situ hybridization (FISH) was used to demonstrate the correct origin of the translocated region, clarifying the karyotype as 46,XY,der(18)t(4;18)(q28.2;q22.2), thus generating information of clinical importance. This illustrates the use of whole chromosome FISH to identify chromosome regions that cannot be determined conclusively using standard cytogenetic banding techniques.

Trisomy 4 in a case of acute lymphocytic leukemia (L1)

Trisomy 4 has been identified previously as a chromosome abnormality associated with acute nonlymphocytic leukemia (ANLL) with myelomonocytic lineage and in myelodysplastic syndromes (MDS). We report a case of acute lymphocytic leukemia (ALL) (French-American-British, FAB L1) in a 42-year-old Japanese man, with trisomy 4 as the sole chromosomal anomaly. Immunophenotypically, the leukemic blasts demonstrated reactivity with CD2, CD5, and CD7 and indicated on early stage of T cell.

Trisomy 4 in acute nonlymphocytic leukemia. Report of two cases and review of the literature

Two patients with M2 subtype of acute nonlymphocytic leukemia (ANLL) and trisomy 4 as a primary karyotype change are described. The abnormality was observed in 100% of bone marrow (BM) metaphases in both cases. It appeared alone in one case and was associated with trisomy 13 in 94% of metaphases in the other. These are the second and third cases of ANLL with trisomy 4 documented in Italy. Neither patient appears to have incurred any environmental or therapeutic insult.