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Kwentoh I, Bugayong ML, Olusoji R, McPherson T, Ahluwalia M. Rare Ring Chromosome [r(15)]: Cytogenetic Abnormality in TP53-Mutated De Novo AML-M4 Masked as Gastrointestinal Bleed With Rapidly Progressing Hyperleukocytosis and Leukostasis. Cureus 2023; 15:e46119. [PMID: 37779685 PMCID: PMC10536451 DOI: 10.7759/cureus.46119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/03/2023] Open
Abstract
TP53-mutated (TP53m) acute myeloid leukemia (AML) comprises only 5-15% of de novo AML, associated with poor survival outcomes due to its resistance to conventional therapy. Ring chromosomes, an even more rare subset of genetic anomalies, occur in only 2% of cases. We report a unique case of de novo AML with both TP53 and ring chromosome anomalies leading to a catastrophic outcome in a 72-year-old male who initially presented with gastrointestinal bleeding (GIB) and urethral stone status post-cystoscopy with J-stent placement. He had no history of chemotherapy use, radiation, benzene exposure, or any other risk factors except for his age. He was noted to have pancytopenia, for which bone marrow biopsy, flow cytometry, and cytogenetic studies were done. Biopsy reported an interesting next-generation sequenced TP53-mutated AML, which correlates with a low rate of response to standard chemotherapy except for bone marrow transplants. Notably, with a complex aberration of 45 XY with multiple translocations (t), deletions (del), inversions (inv), derivative (der) breakpoints, aneuploidy, and rare ring and maker chromosomes, his case was complicated with rapid-onset and very severe hyperleucostasis, reflecting the prognostic value of this rare cytogenetic configuration. The patient expired within 48 hours of diagnosis, despite the urgent initiation of cytoreductive therapy and the mitigation of tumor lysis syndrome with Rasburicase. To the best of our knowledge, this is one of the first AML-M4 patients with rapid-onset leucostasis and the demise of next-generation sequences (NGS) in a de Novo AML patient with this rare complex combination.
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Affiliation(s)
- Ifeoma Kwentoh
- Medicine, Columbia University, New York, USA
- Internal Medicine, Columbia University at Harlem Hospital Center, New York, USA
| | | | - Rahman Olusoji
- Internal Medicine, Columbia University at Harlem Hospital Center, New York, USA
| | - Tasheka McPherson
- Internal Medicine, Columbia University at Harlem Hospital Center, New York, USA
| | - Meena Ahluwalia
- Oncology, Columbia University at Harlem Hospital Center, New York, USA
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von Neuhoff C, Reinhardt D, Sander A, Zimmermann M, Bradtke J, Betts DR, Zemanova Z, Stary J, Bourquin JP, Haas OA, Dworzak MN, Creutzig U. Prognostic Impact of Specific Chromosomal Aberrations in a Large Group of Pediatric Patients With Acute Myeloid Leukemia Treated Uniformly According to Trial AML-BFM 98. J Clin Oncol 2010; 28:2682-9. [DOI: 10.1200/jco.2009.25.6321] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Because cytogenetic data are essential for risk stratification of childhood acute myeloid leukemia (AML), the impact of chromosomal aberrations is crucial. Patients and Methods Data of a large group of patients younger than 18 years treated according to study AML–Berlin-Frankfurt-Münster (BFM) 98 (n = 454), including their cytogenetics, were analyzed. Results The favorable outcome in the subgroups of patients with t(8;21), inv(16), and t(15;17), with an overall survival of 91% (SE, 4%), 92% (SE, 6%), and 87% (SE, 5%), respectively, was confirmed. Within this group, the 5-year probability of event-free survival (pEFS) of all 17 children with t(8;21) and additional aberrations apart from del(9q) or −X/−Y was 100%. As expected, the cytogenetic finding of a complex karyotype (n = 35; pEFS, 33%; SE, 8%) or a monosomy 7 (n = 12; pEFS, 17%; SE, 11%) was associated with a poor outcome. Compared with remaining patients with cytogenetic data (pEFS, 48%; SE, 2%), prognosis in patients with an MLL rearrangement (n = 91) was inferior (pEFS, 34%; SE, 5%; P = .0005). Particularly, children with t(9;11) and additional aberrations (n = 13; pEFS, 31%; SE, 14%) and MLL rearrangements other than t(9;11) and t(11;19) (n = 41; pEFS, 24%; SE, 7%) had an unfavorable outcome. Nine patients with aberrations in 12p showed an adverse prognosis (pEFS, 11%; SE, 10%). The outcome of patients with aberrations of chromosome 5 (n = 13) was better than expected (pEFS, 50%; SE, 13%). Conclusion Because the prognostic value of rare recurrent chromosomal aberrations still has to be elucidated, these data will contribute to future risk stratification for the treatment of pediatric AML.
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Affiliation(s)
- Christine von Neuhoff
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Dirk Reinhardt
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Annette Sander
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Martin Zimmermann
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Jutta Bradtke
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - David R. Betts
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Zuzana Zemanova
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Jan Stary
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Jean-Pierre Bourquin
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Oskar A. Haas
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Michael N. Dworzak
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
| | - Ursula Creutzig
- From Pediatric Hematology/Oncology, Medical School Hannover, Hannover; Pediatric Haematology/Oncology, Oncogenetic Laboratory, Justus-Liebig-Universität Giessen, Giessen; Children's Hospital, Pediatric Hematology/Oncology, University of Münster, Münster Germany; Our Lady's Children's Hospital, National Centre for Medical Genetics, Crumlin, Dublin, Ireland; Center of Oncocytogenetics, Institute of Clinical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine,
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