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Lovatel VL, da Silva BF, Rodrigues EF, da Rosa Borges MLR, de Cássia Barbosa Tavares R, Bueno APS, da Costa ES, de Jesus Marques Salles T, de Souza Fernandez T. Association between Leukemic Evolution and Uncommon Chromosomal Alterations in Pediatric Myelodysplastic Syndrome. Mediterr J Hematol Infect Dis 2024; 16:e2024003. [PMID: 38223485 PMCID: PMC10786138 DOI: 10.4084/mjhid.2024.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024] Open
Abstract
Background Pediatric myelodysplastic syndrome (pMDS) is a group of rare clonal neoplasms with a difficult diagnosis and risk of progression to acute myeloid leukemia (AML). The early stratification in risk groups is essential to choose the treatment and indication for allogeneic hematopoietic stem cell transplantation (HSCT). According to the Revised International Prognostic Scoring System, cytogenetic analysis has demonstrated an essential role in diagnosis and prognosis. In pMDS, abnormal karyotypes are present in 30-50% of the cases. Monosomy 7 is the most common chromosomal alteration associated with poor prognosis. However, the rarity of specific cytogenetic alterations makes its prognosis uncertain. Thus, this study aimed to describe uncommon cytogenetic alterations in a cohort of 200 pMDS patients and their association with evolution to AML. Methods The cytogenetic analysis was performed in 200 pMDS patients by G-banding and fluorescence in situ hybridization between 2000 to 2022. Results Rare chromosome alterations were observed in 7.5% (15/200) of the cases. These chromosome alterations were divided into four cytogenetic groups: hyperdiploidy, biclonal chromosomal alterations, translocations, and uncommon deletions representing 33.3%, 33.3%, 20%, and 13.3%, respectively. Most of these patients (10/15) were classified with advanced MDS (MDS-EB and MDS/AML) and the initial subtype was present in five patients (RCC). The leukemic evolution was observed in 66.66% (10/15) of the patients. Most patients had poor clinical outcomes and they were indicated for HSCT. Conclusion The study of uncommon cytogenetic alterations in pMDS is important to improve the prognosis and guide early indication of HSCT.
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Affiliation(s)
- Viviane Lamim Lovatel
- Cytogenetic Laboratory, Cell and Gene Therapy Program, Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - Beatriz Ferreira da Silva
- Cytogenetic Laboratory, Cell and Gene Therapy Program, Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - Eliane Ferreira Rodrigues
- Cytogenetic Laboratory, Cell and Gene Therapy Program, Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | | | - Rita de Cássia Barbosa Tavares
- Outpatient Department, Bone Marrow Transplantation Center (CEMO), Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - Ana Paula Silva Bueno
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Elaine Sobral da Costa
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Teresa de Souza Fernandez
- Cytogenetic Laboratory, Cell and Gene Therapy Program, Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil
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Pais A, Pande S, Pradhan G, Patil S. A complex karyotype with t(11;12)(q23;p13) translocation with coexistent clones of deletion 5q and cryptic deletion 7q in acute myeloid leukemia. Indian J Cancer 2020; 57:330-333. [DOI: 10.4103/ijc.ijc_473_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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3
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Mahdi T, Rajab A, Padmore R, Porwit A. Characteristics of Lymphoproliferative Disorders with More Than One Aberrant Cell Population as Detected by 10-Color Flow Cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:230-238. [DOI: 10.1002/cyto.b.21402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/06/2016] [Accepted: 07/14/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Talal Mahdi
- Department of Pathology and Laboratory Medicine; the Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; ON Canada
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - Amr Rajab
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - Ruth Padmore
- Department of Pathology and Laboratory Medicine; the Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; ON Canada
| | - Anna Porwit
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
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Otto C, Scholtysik R, Schmitz R, Kreuz M, Becher C, Hummel M, Rosenwald A, Trümper L, Klapper W, Siebert R, Küppers R. NovelIGHandMYCTranslocation Partners in Diffuse Large B-Cell Lymphomas. Genes Chromosomes Cancer 2016; 55:932-943. [DOI: 10.1002/gcc.22391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Claudia Otto
- Institute of Cell Biology (Cancer Research); University of Duisburg-Essen, Medical School; Essen Germany
| | - René Scholtysik
- Institute of Cell Biology (Cancer Research); University of Duisburg-Essen, Medical School; Essen Germany
| | - Roland Schmitz
- Institute of Cell Biology (Cancer Research); University of Duisburg-Essen, Medical School; Essen Germany
| | - Markus Kreuz
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE); University of Leipzig; Leipzig Germany
| | - Claudia Becher
- Institute of Human Genetics; Christian-Albrechts University Kiel & University Hospital Schleswig-Holstein; Kiel Germany
| | | | | | - Lorenz Trümper
- Department of Hematology/Oncology; University Hospital Göttingen; Göttingen Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry; University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts-University; Kiel Germany
| | - Reiner Siebert
- Institute of Human Genetics; Christian-Albrechts University Kiel & University Hospital Schleswig-Holstein; Kiel Germany
- Institute of Human Genetics; University of Ulm; Ulm Germany
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research); University of Duisburg-Essen, Medical School; Essen Germany
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Cytogenetically Unrelated Clones in Acute Myeloid Leukemia Showing Different Responses to Chemotherapy. Case Rep Hematol 2016; 2016:2373902. [PMID: 27034857 PMCID: PMC4806274 DOI: 10.1155/2016/2373902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
We report a case of acute myeloid leukemia (AML) with two cytogenetically unrelated clones. The patient was a 45-year-old male who was diagnosed with acute monoblastic leukemia (AMoL). Initial G-band analysis showed 51,XY,+6,+8,inv(9)(p12q13)c,+11,+13,+19[12]/52,idem,+Y[8], but G-band analysis after induction therapy showed 45,XY,-7,inv(9)(p12q13)c[19]/46,XY,inv(9)(p12q13)c[1]. Retrospective FISH analysis revealed a cryptic monosomy 7 clone in the initial AML sample. The clone with multiple trisomies was eliminated after induction therapy and never recurred, but a clone with monosomy 7 was still detected in myelodysplastic marrow with a normal blast percentage. Both clones were successfully eliminated after related peripheral blood stem cell transplantation, but the patient died of relapsed AML with monosomy 7. We concluded that one clone was de novo AMoL with chromosome 6, 8, 11, 13, and 19 trisomy and that the other was acute myeloid leukemia with myelodysplasia-related changes(AML-MRC) with chromosome 7 monosomy showing different responses to chemotherapy. Simultaneous onset of cytogenetically unrelated hematological malignancies that each have a different disease status is a rare phenomenon but is important to diagnose for a correct understanding of the disease status and for establishing an appropriate treatment strategy.
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Yin CC, Tang G, Lu G, Feng X, Keating MJ, Medeiros LJ, Abruzzo LV. Del(20q) in patients with chronic lymphocytic leukemia: a therapy-related abnormality involving lymphoid or myeloid cells. Mod Pathol 2015; 28:1130-7. [PMID: 25953391 PMCID: PMC4522203 DOI: 10.1038/modpathol.2015.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/16/2022]
Abstract
Deletion 20q (Del(20q)), a common cytogenetic abnormality in myeloid neoplasms, is rare in chronic lymphocytic leukemia. We report 64 patients with chronic lymphocytic leukemia and del(20q), as the sole abnormality in 40, a stemline abnormality in 21, and a secondary abnormality in 3 cases. Fluorescence in situ hybridization (FISH) analysis revealed an additional high-risk abnormality, del(11q) or del(17p), in 25/64 (39%) cases. In most cases, the leukemic cells showed atypical cytologic features, unmutated IGHV (immunoglobulin heavy-chain variable region) genes, and ZAP70 positivity. The del(20q) was detected only after chemotherapy in all 27 cases with initial karyotypes available. With a median follow-up of 90 months, 30 patients (47%) died, most as a direct consequence of chronic lymphocytic leukemia. Eight patients developed a therapy-related myeloid neoplasm, seven with a complex karyotype. Combined morphologic and FISH analysis for del(20q) performed in 12 cases without morphologic evidence of a myeloid neoplasm localized the del(20q) to the chronic lymphocytic leukemia cells in 5 (42%) cases, and to myeloid/erythroid cells in 7 (58)% cases. The del(20q) was detected in myeloid cells in all 4 cases of myelodysplastic syndrome. In aggregate, these data indicate that chronic lymphocytic leukemia with del(20q) acquired after therapy is heterogeneous. In cases with morphologic evidence of dysplasia, the del(20q) likely resides in the myeloid lineage. However, in cases without morphologic evidence of dysplasia, the del(20q) may represent clonal evolution and disease progression. Combining morphologic analysis with FISH for del(20q) or performing FISH on immunomagnetically selected sub-populations to localize the cell population with this abnormality may help guide patient management.
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Affiliation(s)
- C. Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Gary Lu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Xiaoli Feng
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Michael J. Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Lynne V. Abruzzo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
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7
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Porwit A. Immunophenotyping of selected hematologic disorders - focus on lymphoproliferative disorders with more than one malignant cell population. Int J Lab Hematol 2013; 35:275-82. [DOI: 10.1111/ijlh.12080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Porwit
- Department of Pathobiology and Laboratory Medicine; University of Toronto; University Health Network; Toronto ON Canada
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Saito H, Otsubo K, Kakimoto A, Komatsu N, Ohsaka A. Emergence of two unrelated clones in acute myeloid leukemia with MLL-SEPT9 fusion transcript. ACTA ACUST UNITED AC 2010; 201:111-5. [PMID: 20682395 DOI: 10.1016/j.cancergencyto.2010.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 05/12/2010] [Accepted: 05/26/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Hajime Saito
- Department of Internal Medicine, Mitochuo Hospital, Mito, Ibaraki, Japan
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Prabhu S, Gottlieb DJ, Varikatt W, St Heaps L, Diaz S, Smith A. Adult B-cell acute lymphoblastic leukemia with two unrelated abnormal cytogenetic clones. ACTA ACUST UNITED AC 2010; 201:24-7. [PMID: 20633764 DOI: 10.1016/j.cancergencyto.2010.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 03/31/2010] [Accepted: 04/18/2010] [Indexed: 01/18/2023]
Abstract
The presence of two different abnormal cell lines at diagnosis in hematologic malignancies is rare and raises the question of etiology and pathogenesis--two separate malignant lineages occurring together or a common stem cell malignancy? We present a 64-year-old woman who was evaluated for low platelet count and peripheral blasts. On the basis of the morphology, flow cytometry, and lack of myeloid-associated markers, a diagnosis of precursor B-cell acute lymphoblastic leukemia (B-ALL) was made. Cytogenetic analysis of the diagnostic bone marrow (BM) specimen revealed two unrelated abnormal clones--one had a dicentric (7;9)(p11;p11), resulting in the deletion of 7p and 9p, and the other had only trisomy 8. The dic(7;9) is a rare but recurrent abnormality in B-ALL, while trisomy 8 as a sole abnormality is most commonly associated with myeloid malignancies. After standard treatment for B-ALL, BM cytogenetic analysis showed disappearance of the dic(7;9) cell line but persistence of cells with trisomy 8. The presence of two unrelated clones suggestive of concomitant malignancies, possibly B-ALL with an underlying MDS, may have arisen by different mechanisms.
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Affiliation(s)
- S Prabhu
- Department of Cytogenetics, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
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Zeidan A, Phatak P. Acquired biclonal chromosome X aberrations without autosomal chromosomal anomalies in acute myeloid leukemia. ACTA ACUST UNITED AC 2008; 181:125-30. [PMID: 18295665 DOI: 10.1016/j.cancergencyto.2007.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 11/12/2007] [Accepted: 11/21/2007] [Indexed: 11/19/2022]
Abstract
Acquired clonal chromosome X aberrations, whether numerical or structural, as the sole chromosomal anomaly in acute myeloid leukemia (AML) are very uncommon. The scarcity of nonconstitutional chromosome X aberrations detected in AML has prevented any meaningful evaluation of their prognostic significance. In this report, we describe the case of a patient with AML who had the unusual acquired karyotype of 45,X/-X,46,X,i(X)(q10) on presentation and 45,X,-X,add(19)(p13.3) on relapse. We also briefly review the literature on acquired numerical and structural chromosome X aberrations as the sole chromosomal anomaly in AML. This case adds to the sparse body of literature regarding chromosome X aberrations in AML. More case reports are needed to further elucidate the importance of such aberrations.
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Affiliation(s)
- Amer Zeidan
- Division of Hospital Medicine, Department of Medicine, Rochester General Hospital, Rochester, NY 14621, USA.
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12
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Rodrigues EF, de Souza DC, Camargo A, Tavares RDC, Bouzas LF, Ornellas MH, Fernandez TDS. Cytogenetic biclonality in a child with hypocellular primary myelodysplastic syndrome. ACTA ACUST UNITED AC 2007; 178:70-2. [PMID: 17889712 DOI: 10.1016/j.cancergencyto.2007.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 05/21/2007] [Accepted: 05/31/2007] [Indexed: 11/28/2022]
Abstract
A 13-year-old boy with hypocellular primary myelodysplastic syndrome, classified as refractory cytopenia, underwent umbilical cord blood transplantation. Cytogenetic analysis revealed two rare biclonal chromosomal aberrations, del(17)(p12) and del(11)(q23). Cytogenetic analysis was a valuable tool in diagnosis, in clinical decision-making, and in treatment and follow-up. To our knowledge, this is the first reported case of cytogenetic biclonality involving chromosomes 17 and 11.
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Affiliation(s)
- Eliane Ferreira Rodrigues
- Cytogenetic Laboratory, Bone Marrow Transplant Center, National Cancer Institute (INCA), Praça Cruz Vermelha, CEP 20230-130, Rio de Janeiro, RJ, Brazil
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13
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Abstract
Chromosome aberrations, in particular translocations and their corresponding gene fusions, have an important role in the initial steps of tumorigenesis; at present, 358 gene fusions involving 337 different genes have been identified. An increasing number of gene fusions are being recognized as important diagnostic and prognostic parameters in malignant haematological disorders and childhood sarcomas. The biological and clinical impact of gene fusions in the more common solid tumour types has been less appreciated. However, an analysis of available data shows that gene fusions occur in all malignancies, and that they account for 20% of human cancer morbidity. With the advent of new and powerful investigative tools that enable the detection of cytogenetically cryptic rearrangements, this proportion is likely to increase substantially.
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Affiliation(s)
- Felix Mitelman
- Lund University, Department of Clinical Genetics, Lund University Hospital, SE-221 85 Lund, Sweden.
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Cho HS, Hyun MS. A Novel Jumping Translocation of 12q21 in a Patient with Chronic Idiopathic Myelofibrosis. THE KOREAN JOURNAL OF HEMATOLOGY 2006. [DOI: 10.5045/kjh.2006.41.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hee Soon Cho
- Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Myung Soo Hyun
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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