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Luo L, Wang X, Luo J, Zheng S, Gong N, He Y, Xi Q, Chen J, Jiang T, Zhong L. Acute undifferentiated leukemia with undifferentiated myeloid sarcoma: Case report and literature review. Medicine (Baltimore) 2024; 103:e36948. [PMID: 38277531 PMCID: PMC10817018 DOI: 10.1097/md.0000000000036948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND With the advancement of diagnostic technology, true acute undifferentiated leukemia (AUL) is becoming more rare, and AUL with extramedullary sarcoma has not been reported. CASE PRESENTATION This article reports a case of AUL with extramedullary sarcoma. Flow cytometric analysis of the bone marrow and lymph nodes indicated that the tumor cells of both were of the same origin and mainly expressed stem cell markers and CD7, no myeloid-specific markers, T-lymphoblastic-related markers, and B-lymphoblastic-related markers. Although the priming regimen combined with azacitidine was ineffective, complete remission was achieved by switching to azacitidine combined with HIA (homoharringtonine, idarubicin plus Ara-C). CONCLUSION To diagnosis de novo acute leukemia with extensive and comprehensive cellular immune maker detection is available and credible, the expression of a single relatively nonspecific myeloid antigen as a immune maker to detect AUL or AUL associated with sarcoma is precise and effective in our case, which patient was benefit from HIA regiment.
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Affiliation(s)
- Lan Luo
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaoqing Wang
- Department of Hematology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Ji Luo
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shuai Zheng
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ninghan Gong
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yuan He
- Department of Clinical and Experimental Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Qian Xi
- Department of Clinical and Experimental Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Jiao Chen
- Department of pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Tao Jiang
- Department of pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Ling Zhong
- Human Disease Genes Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Rai V, Brahmbhatt B, Saha A, Thayakaran IP. Clinico-hematological and immunophenotypic profile of acute leukemia of ambiguous lineage: A four year experience from a single tertiary care centre of West India. INDIAN J PATHOL MICR 2024; 67:121-127. [PMID: 38358200 DOI: 10.4103/ijpm.ijpm_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background : Acute leukemia of ambiguous lineage (ALAL) is a heterogeneous group of rare leukemias that lacks definite evidence of differentiation along one lineage. It includes acute undifferentiated leukemia and mixed-phenotype acute Leukaemia (MPAL). Aims The present study highlighted the clinicohematological and immunophenotypic profile of ALAL cases diagnosed in the tertiary care centre of western India. Study Design Retrospective observational study. Methods and Materials Patients diagnosed with acute leukemia, preferably their bone marrow aspirate samples, were collected in ethylene diamine tetra-acetic acid-vial. The immunophenotypic study was done using the Fluorescence Activated Cell Sorting (FACS) Canto Eight color flow cytometer and a broad panel of monoclonal antibodies. The patients were diagnosed for ALAL, based on the World Health Organization (WHO) 2017 classification. Statistical Analysis Used Descriptive statistics with categorical and continuous variables. Results Overall incidence of ALAL was about 2.1%, and singly MPAL and AUL were 1.8%, and 0.3%, in frequency, respectively. The age range was 4 to 57 (median age 21 years), of which 11 (57.9%) were adults and eight were children (42.1%). There was male predominance with Male: Female ratio of 5.3:1. On immunophenotyping, B/myeloid MPAL (42.1%) was the commonest among the ALAL. Translocation t(9;22) was the most common cytogenetic abnormality found mainly in B/myeloid MPAL. Two cases were of chronic myeloid leukemia in a mixed phenotypic blast crisis. Over all prognosis of ALAL was poor. Conclusion ALAL is overall associated with poor prognosis as both their diagnosis and treatment decisions are difficult owing to the lack of optimum treatment data and the rarity of the disease. Hence, A careful diagnosis with the help of immunophenotyping is crucial.
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Affiliation(s)
- Varnika Rai
- Oncopathology Department, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Beena Brahmbhatt
- Oncopathology Department, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Anurag Saha
- Oncopathology Department, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Immanuel P Thayakaran
- Oncopathology Department, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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3
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Kurzer JH, Weinberg OK. Advances in Flow Cytometry for Mixed Phenotype and Ambiguous Leukemias. Clin Lab Med 2023; 43:399-410. [PMID: 37481319 DOI: 10.1016/j.cll.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
This review discusses recent updates in the diagnosis of acute leukemias of ambiguous lineage and emphasizes the necessary elements for proper flow cytometric evaluation of these cases. The current emphasis of the classification system is toward interpreting the marker expression in light of the intensity of lineage markers and avoiding a diagnosis of mixed phenotype acute leukemia based solely on immunophenotyping without considering underlying genetic findings. Novel entities including mixed phenotype acute leukemia with ZNF384 rearrangements and acute leukemias of ambiguous lineage with BCL11B rearrangements seem to show characteristic flow cytometric immunophenotypes discussed here.
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Affiliation(s)
- Jason H Kurzer
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H1524B, Stanford, CA 94305-5324, USA.
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern, Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9072, USA
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Weinberg OK, Dennis J, Zia H, Chen P, Chu A, Koduru P, Luu HS, Fuda F, Chen W. Adult mixed phenotype acute leukemia (MPAL): B/myeloid MPAL isoMPO is distinct from other MPAL subtypes. Int J Lab Hematol 2023; 45:170-178. [PMID: 36325594 DOI: 10.1111/ijlh.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Myeloperoxidase (MPO) is considered a specific marker of myeloid/non-monocytic lineage in the diagnosis of mixed phenotype acute leukemia (MPAL). However, the clinical significance of isolated dim MPO expression in otherwise typical B lymphoblastic leukemia (B-ALL; referred to as B/myeloid MPALisoMPO ) in adult patients is unknown. METHODS We compared flow cytometric immunophenotype and clinicopathological findings among cases of B/myeloid MPALisoMPO (n = 13), other MPAL subtypes (n = 10, B/myeloid and T/myeloid MPAL), B-ALL (n = 64), and acute myeloid leukemia (AML, n = 58), using the 2016 WHO classification. For MPAL cases, MPO was reported as the percent of MPO positive blasts and its intensity (dim or moderate/strong). The pattern of heterogenous antigen expression (inversely coordinated expression between myeloid and lymphoid markers and cell size) was assessed. RESULTS Cases of B/myeloid MPALisoMPO showed a fairly homogenous single B-lineage blast population with dim MPO expression whereas cases of other MPAL subtypes displayed heterogeneous antigen expression and moderate/strong MPO expression. The percent of MPO positive blasts in these two groups was similar. Expressions of CD15, CD117, and monocytic markers were more common in other MPAL than in B/myeloid MPALisoMPO . B/myeloid MPALisoMPO patients had similar overall and leukemia free survivals as B-ALL patients and better than other MPAL patients. CONCLUSION This is the first study to investigate the clinical significance of adult B/myeloid MPALisoMPO using the 2016 WHO classification. Our results suggest that B/myeloid MPALisoMPO clinically behaves more similarly to B-ALL than to other MPAL subtypes, supporting the 2016 WHO classification to segregate this entity from other MPAL subtypes.
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Affiliation(s)
- Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jake Dennis
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hamid Zia
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pu Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Laboratory Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Andrew Chu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prasad Koduru
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Franklin Fuda
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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5
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Iacobucci I, Witkowski MT, Mullighan CG. Single-cell analysis of acute lymphoblastic and lineage-ambiguous leukemia: approaches and molecular insights. Blood 2023; 141:356-368. [PMID: 35926109 PMCID: PMC10023733 DOI: 10.1182/blood.2022016954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 01/31/2023] Open
Abstract
Despite recent progress in identifying the genetic drivers of acute lymphoblastic leukemia (ALL), prognosis remains poor for those individuals who experience disease recurrence. Moreover, acute leukemias of ambiguous lineage lack a biologically informed framework to guide classification and therapy. These needs have driven the adoption of multiple complementary single-cell sequencing approaches to explore key issues in the biology of these leukemias, including cell of origin, developmental hierarchy and ontogeny, and the molecular heterogeneity driving pathogenesis, progression, and therapeutic responsiveness. There are multiple single-cell techniques for profiling a specific modality, including RNA, DNA, chromatin accessibility and methylation; and an expanding range of approaches for simultaneous analysis of multiple modalities. Single-cell sequencing approaches have also enabled characterization of cell-intrinsic and -extrinsic features of ALL biology. In this review we describe these approaches and highlight the extensive heterogeneity that underpins ALL gene expression, cellular differentiation, and clonal architecture throughout disease pathogenesis and treatment resistance. In addition, we discuss the importance of the dynamic interactions that occur between leukemia cells and the nonleukemia microenvironment. We discuss potential opportunities and limitations of single-cell sequencing for the study of ALL biology and treatment responsiveness.
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Affiliation(s)
- Ilaria Iacobucci
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, TN
| | - Matthew T. Witkowski
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Charles G. Mullighan
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, TN
- Hematological Malignancies Program, St Jude Children’s Research Hospital, Memphis, TN
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6
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Hayashino K, Matsuda M, Fujishita K, Iwata J, Mizobuchi M, Uemura M, Yorita K, Maeshima A, Imai T. Acute undifferentiated leukemia limited to neck lymph nodes and a large mediastinal mass. J Clin Exp Hematop 2022; 62:222-225. [PMID: 36261335 PMCID: PMC9898720 DOI: 10.3960/jslrt.22012] [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] [Indexed: 11/06/2022] Open
Abstract
In the 2016 update of the World Health Organization (WHO) classification of myeloid neoplasms, acute undifferentiated leukemia (AUL) was defined by a lack of lineage-specific markers. AUL has very poor prognosis and no established therapies due to its rarity. We report a case of a 31-year-old man with AUL who showed complete molecular response to an acute lymphoblastic leukemia (ALL)-based regimen and received allogeneic hematopoietic stem cell transplantation. The patient's blast cells were CD7-positive and localized to lymph nodes in the neck and to a large mediastinal mass; there was also rearrangement of the T-cell receptor delta locus. Although the tumor showed characteristics of T-cell lymphoblastic lymphoma, it was categorized as AUL based on WHO classification. This case suggests that a high-intensity conditioning regimen could be effective for rare cases of AUL that present only in the extramedullary mass, and chemotherapy for AUL should be selected based on the characteristics of the blasts.
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Affiliation(s)
- Kenta Hayashino
- Department of hematology, Kochi health sciences center, Kochi, Japan
| | - Masayuki Matsuda
- Department of hematology, Kochi health sciences center, Kochi, Japan
| | - Keigo Fujishita
- Department of hematology, Kochi health sciences center, Kochi, Japan
| | - Jun Iwata
- Department of diagnostic of pathology, Kochi health sciences center, Kochi, Japan
| | - Miki Mizobuchi
- Department of hematology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Munenori Uemura
- Department of hematology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kenji Yorita
- Department of diagnostic pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Akiko Maeshima
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshi Imai
- Department of hematology, Kochi health sciences center, Kochi, Japan
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7
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Wang N, He J, Liu F. Venetoclax in Combination with Hypomethylating Agents for the Treatment of Treatment-Naive B/Myeloid Mixed-Phenotype Acute Leukemia and Relapsed/Refractory Acute Myeloid Leukemia: A Report of 3 Cases. Chemotherapy 2022; 67:178-182. [DOI: 10.1159/000519882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/25/2021] [Indexed: 01/14/2023]
Abstract
B/myeloid mixed-phenotype acute leukemia (MPAL) is an uncommon and aggressive leukemia without well-established treatment guidelines and has an inferior outcome. Relapsed/refractory (R/R) acute myeloid leukemia (AML) that is ineligible for aggressive chemotherapy regimens and allogeneic hematopoietic stem-cell transplantation has an extremely poor prognosis. The novel regimen of venetoclax (VEN) combined with hypomethylating agents (HMAs) has a synergistic therapeutic effect and a tolerable safety profile, which has been officially approved by the US Food and Drug Administration (FDA) for newly diagnosed AML in adults who are 75 years or older or patients precluding intensive induction chemotherapy. For R/R and other rare types of AML, no consensus has been reached on the efficacy of VEN-HMA. In addition, there is no available report on treatment-naive B/myeloid MPAL with VEN-HMA. Herein, we present 3 cases of VEN-HMA in treatment-naive B/myeloid MPAL and R/R AML. Its potential efficacy is worthy of further exploration in future researches.
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8
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Dickerson KM, Qu C, Gao Q, Iacobucci I, Gu Z, Yoshihara H, Backhaus EA, Chang Y, Janke LJ, Xu B, Wu G, Papachristou EK, D'Santos CS, Roberts KG, Mullighan CG. ZNF384 fusion oncoproteins drive lineage aberrancy in acute leukemia. Blood Cancer Discov 2022; 3:240-263. [PMID: 35247902 DOI: 10.1158/2643-3230.bcd-21-0163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/21/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
ZNF384-rearranged fusion oncoproteins (FO) define a subset of lineage ambiguous leukemias, but their mechanistic role in leukemogenesis and lineage ambiguity is poorly understood. Using viral expression in mouse and human hematopoietic stem and progenitor cells (HSPCs) and a Ep300::Znf384 knockin mouse model, we show that ZNF384 FO promote hematopoietic expansion, myeloid lineage skewing, and self-renewal. In mouse HSPCs, concomitant lesions, such as NRASG12D, were required for fully penetrant leukemia, whereas in human HSPCs expression of ZNF384 FO drove B/myeloid leukemia, with sensitivity of a ZNF384-rearranged xenograft to FLT3 inhibition in vivo. Mechanistically, ZNF384 FO occupy a subset of predominantly intragenic/enhancer regions with increased histone 3 lysine acetylation and deregulate expression of hematopoietic stem cell transcription factors. These data define a paradigm for FO-driven lineage ambiguous leukemia, in which expression in HSPCs results in deregulation of lineage-specific genes and hematopoietic skewing, progressing to full leukemia in the context of proliferative stress.
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Affiliation(s)
| | - Chunxu Qu
- St. Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Qingsong Gao
- St. Jude Children's Research Hospital, Memphis, United States
| | - Ilaria Iacobucci
- St. Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Zhaohui Gu
- City Of Hope National Medical Center, United States
| | | | - Emily A Backhaus
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yunchao Chang
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Laura J Janke
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Beisi Xu
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Gang Wu
- St. Jude Children's Research Hospital, Memphis, United States
| | | | - Clive S D'Santos
- Cancer Research UK Cambridge Research Institute, Cambridge, United Kingdom
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9
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OUP accepted manuscript. Am J Clin Pathol 2022; 158:27-34. [DOI: 10.1093/ajcp/aqac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/05/2022] [Indexed: 11/12/2022] Open
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10
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Transient myeloproliferative disorder as the presenting feature for mosaic trisomy 21. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006126. [PMID: 34789514 PMCID: PMC8751406 DOI: 10.1101/mcs.a006126] [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: 06/30/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Trisomy 21 is a common congenital disorder with well-documented clinical manifestations, including an increased risk for the transient myeloproliferative disorder as a neonate and leukemia in childhood and adolescence. Transient myeloproliferative disorder is only known to occur in hematopoietic cells with trisomy 21. Children with mosaic trisomy 21 also have a risk for hematological malignancies. We present a nondysmorphic neonate, with a negative noninvasive prenatal screening of maternal blood for trisomy 21, who came to medical attention because of ruddy skin. He was found to have mild polycythemia, thrombocytopenia, and developed peripheral blasts. His clinical presentation was consistent with transient myeloproliferative disorder, which is only seen with trisomy 21. Cytogenetic studies of peripheral blood are positive for mosaic trisomy 21.
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11
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Chang TY, Chen SH, Jaing TH, Yang SH, Wen YC, Yang CP, Hung IJ. Cytogenetic aberration in mixed-phenotype acute leukemia in children: A single-center retrospective review. Pediatr Neonatol 2021; 62:21-25. [PMID: 32859541 DOI: 10.1016/j.pedneo.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Mixed-phenotype acute leukemia (MPAL) poses a diagnostic and therapeutic dilemma. No consensus exists on the strategy to assign patients with MPAL to either lymphoid- or myeloid-directed treatment. Thus, a better understanding of the characteristics of MPAL is a crucial unmet need. This study aims to provide information on a population-based cohort of children who received treatment based on standard, simple immunophenotypic criteria. METHODS Single-center, retrospective clinical and laboratory reviews of patients with MPAL were provided by morphology, immunophenotyping, cytogenetics, and molecular methods. We identified 242 flow cytometry samples. Of all consecutive pediatric patients with acute leukemia, we identified 8 (3.3%) patients with MPAL fulfilling WHO 2016 criteria; these were classified as follows: B-lymphoid + myeloid (n = 4), T-lymphoid + myeloid (n = 2), and B + T-lymphoid (n = 2). RESULTS Of 8 MPAL cases, 4 were boys and 4 girls [median age at diagnosis: 10.8 (range 1.1-17) years]. The b3a2 (p210) and e1a2 (p190) BCR/ABL fusion transcripts were detected in 1 patient with B/myeloid MPAL. Regarding the morphology, all patients were initially diagnosed as acute lymphoblastic leukemia, but no morphological characteristics or cytogenetic aberration was particularly predictive of an MPAL. Furthermore, 4 of 8 patients (50%) with MPAL were associated with chromosome 21 monosomy or partial trisomy. CONCLUSION Despite no single recurrent chromosomal abnormality that could serve as a hallmark lesion in MPAL, cytogenetic alterations are frequent and predominantly associated with complex karyotype involving chromosome 21 abnormalities.
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Affiliation(s)
- Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Shu-Ho Yang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Iou-Jih Hung
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
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12
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Berg HE, Blackburn PR, Baughn LB, Ketterling RP, Xu X, Greipp PT, Hoppman NL, Smadbeck JB, Vasmatzis G, Shi M, Reichard KK, Viswanatha DS, Jevremovic D, Maher GM, Peterson JF. Identification of a novel KMT2A/GIMAP8 gene fusion in a pediatric patient with acute undifferentiated leukemia. Genes Chromosomes Cancer 2020; 60:108-111. [PMID: 33078871 DOI: 10.1002/gcc.22902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 01/05/2023] Open
Abstract
Acute undifferentiated leukemia (AUL) is a very rare hematologic neoplasm that expresses no markers specific for either myeloid or lymphoid lineages. While commonly observed in several acute leukemias, KMT2A rearrangements in AUL have been rarely reported in the literature. We report the third case to our knowledge of AUL harboring a KMT2A rearrangement. Furthermore, the KMT2A/GIMAP8 gene fusion identified in this case represents a novel KMT2A rearrangement.
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Affiliation(s)
- Holly E Berg
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick R Blackburn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Xinjie Xu
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole L Hoppman
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - James B Smadbeck
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, Minnesota, USA
| | - George Vasmatzis
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, Minnesota, USA
| | - Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kaaren K Reichard
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Viswanatha
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - George M Maher
- Divison of Pediatric Hematology/Oncology, Sanford Children's Hospital, Sioux Falls, South Dakota, USA
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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13
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Venetoclax and Decitabine for T/Myeloid Mixed-Phenotype Acute Leukemia Not Otherwise Specified (MPAL NOS). Case Rep Hematol 2020; 2020:8811673. [PMID: 33101740 PMCID: PMC7569429 DOI: 10.1155/2020/8811673] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022] Open
Abstract
T/myeloid mixed-phenotype acute leukemia not otherwise specified (MPAL NOS) is an uncommon and aggressive leukemia without well-established treatment guidelines, particularly when relapsed. Venetoclax plus a hypomethylating agent offers a promising option in this situation since studies support its use in both acute myeloid and, albeit with fewer data to date, acute T-cell-lymphoblastic leukemias. We report the successful eradication of T/myeloid MPAL NOS relapsed after allogeneic stem cell transplant with venetoclax plus decitabine. A consolidative allogeneic stem cell transplant from a second donor was subsequently performed, and the patient remained without evidence of disease more than one year later. Further investigation is indicated to evaluate venetoclax combined with hypomethylating agents and/or other therapies for the management of T/myeloid MPAL NOS.
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