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Kushwaha R, Verma SP, Yadav G. Philadelphia-positive de novo myelodysplastic syndrome: A new entity with review of literature. Indian J Cancer 2021; 58:463-468. [PMID: 34380833 DOI: 10.4103/ijc.ijc_282_20] [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]
Affiliation(s)
- Rashmi Kushwaha
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S P Verma
- Department of Clinical Hematology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Geeta Yadav
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
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2
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Chelapareddy LR, Sen S. Philadelphia Translocation in MDS: A Case Report and a Brief Review of the Literature Looking at Its Prevalence, Disease Progression, and Treatment Options. Case Rep Hematol 2018; 2018:5865321. [PMID: 30595928 PMCID: PMC6282134 DOI: 10.1155/2018/5865321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/17/2018] [Accepted: 11/08/2018] [Indexed: 11/27/2022] Open
Abstract
Myelodysplastic syndrome (MDS) is a group of clonal disorders characterized by ineffective and dysplastic hematopoiesis in the bone marrow with variable risk of progression to leukemia. MDS is characterized by specific karyotypic and molecular abnormalities. The t(9 : 22) Philadelphia translocation is not a common abnormality found in MDS, and it is not included in the prognostic indices for germline mutations. There are no definitive treatment guidelines for these patients either. Here, we reviewed previously reported cases of MDS with the Philadelphia translocation with a goal to determine their prognosis and treatment options, specifically the tyrosine kinase inhibitors (TKIs).
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Affiliation(s)
| | - Sandeep Sen
- SSM Health St. Mary's Hospital, St. Louis, Missouri 63117, USA
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3
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Secondary Philadelphia chromosome acquired during therapy of acute leukemia and myelodysplastic syndrome. Mod Pathol 2018; 31:1141-1154. [PMID: 29449681 DOI: 10.1038/s41379-018-0014-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 11/08/2022]
Abstract
The Philadelphia chromosome resulting from t(9;22)(q34;q11.2) or its variants is a defining event in chronic myeloid leukemia. It is also observed in several types of de novo acute leukemia, commonly in B lymphoblastic leukemia, and rarely in acute myeloid leukemia, acute leukemia of ambiguous lineage, and T lymphoblastic leukemia. Acquisition of the Philadelphia chromosome during therapy of acute leukemia and myelodysplastic syndrome is rare. We reported 19 patients, including 11 men and 8 women with a median age of 53 years at initial diagnosis. The diagnoses at initial presentation were acute myeloid leukemia (n = 11), myelodysplastic syndrome (n = 5), B lymphoblastic leukemia (n = 2), and T lymphoblastic leukemia (n = 1); no cases carried the Philadelphia chromosome. The Philadelphia chromosome was detected subsequently at relapse, or at refractory stage of acute leukemia or myelodysplastic syndrome. Of 14 patients evaluated for the BCR-ABL1 transcript subtype, 12 had the e1a2 transcript. In 11 of 14 patients, the diseases before and after emergence of the Philadelphia chromosome were clonally related by karyotype or shared gene mutations. Of 15 patients with treatment information available, 7 received chemotherapy alone, 5 received chemotherapy plus tyrosine kinase inhibitors, 2 received tyrosine kinase inhibitors only, and 1 patient was not treated. Twelve patients had follow-up after acquisition of the Philadelphia chromosome; all had persistent/refractory acute leukemia. Thirteen of 15 patients died a median of 3 months after the emergence of the Philadelphia chromosome. In summary, secondary Philadelphia chromosome acquired during therapy is rare, and is associated with the e1a2 transcript subtype, terminal disease stage, and poor outcome.
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4
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Uncovering Clinical Features of De Novo Philadelphia Positive Myelodysplasia. Case Rep Hematol 2017; 2017:5404131. [PMID: 28321349 PMCID: PMC5339529 DOI: 10.1155/2017/5404131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/24/2017] [Indexed: 11/25/2022] Open
Abstract
Myelodysplastic syndrome (MDS) is cytogenetically heterogeneous and retains variable risk for acute myeloid leukemia transformation. Though not yet fully understood, there is an association between genetic abnormalities and defects in gene expression. The functional role for infrequent cytogenetic alteration remains unclear. An uncommon chromosomic abnormality is the presence of the Philadelphia (Ph) chromosome. Here, we report a patient with Ph+ MDS treated with low dose Dasatinib who achieved hematologic response for 7 months. In addition, we also examined the English literature on all de novo Ph + MDS cases between 1996 and 2015 to gain insight into clinical features and outcome.
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5
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BCR-ABL-positive acute myeloid leukemia: a new entity? Analysis of clinical and molecular features. Ann Hematol 2016; 95:1211-21. [PMID: 27297971 DOI: 10.1007/s00277-016-2721-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/30/2016] [Indexed: 01/07/2023]
Abstract
BCR-ABL-positive acute myeloid leukemia (AML) is a rare subtype of AML that is now included as a provisional entity in the 2016 revised WHO classification of myeloid malignancies. Since a clear distinction between de novo BCR-ABL+ AML and chronic myeloid leukemia (CML) blast crisis is challenging in many cases, the existence of de novo BCR-ABL+ AML has been a matter of debate for a long time. However, there is increasing evidence suggesting that BCR-ABL+ AML is in fact a distinct subgroup of AML. In this study, we analyzed all published cases since 1975 as well as cases from our institution in order to present common clinical and molecular features of this rare disease. Our analysis shows that BCR-ABL predominantly occurs in AML-NOS, CBF leukemia, and AML with myelodysplasia-related changes. The most common BCR-ABL transcripts (p190 and p210) are nearly equally distributed. Based on the analysis of published data, we provide a clinical algorithm for the initial differential diagnosis of BCR-ABL+ AML. The prognosis of BCR-ABL+ AML seems to depend on the cytogenetic and/or molecular background rather than on BCR-ABL itself. A therapy with tyrosine kinase inhibitors (TKIs) such as imatinib, dasatinib, or nilotinib is reasonable, but-due to a lack of systematic clinical data-their use cannot be routinely recommended in first-line therapy. Beyond first-line treatment of AML, the use of TKI remains an individual decision, both in combination with intensive chemotherapy and/or as a bridge to allogeneic stem cell transplantation. In each single case, potential benefits have to be weighed against potential risks.
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6
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Seo BY, Lee JH, Kang MG, Choi SY, Kim SH, Shin JH, Suh SP, Ryang DW, Shin MG. Cryptic e1a2 BCR-ABL1 fusion with complex chromosomal abnormality in de novo myelodysplastic syndrome. Ann Lab Med 2015; 35:643-6. [PMID: 26354355 PMCID: PMC4579111 DOI: 10.3343/alm.2015.35.6.643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/25/2015] [Accepted: 08/14/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bo Young Seo
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jun Hyoung Lee
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Min Gu Kang
- Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seok Yong Choi
- Brain Korea 21 Plus Project, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Hyun Kim
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Soon Pal Suh
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Dong Wook Ryang
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Myung Geun Shin
- Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea.,Brain Korea 21 Plus Project, Chonnam National University Medical School, Gwangju, Korea.,Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea.
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7
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Zhang L, Bennett JM, Zhang X, Moscinski L, Ibarz-Pinilla J, List AF, Komrokji R. Uncommon of the Uncommon: Low-Grade Myelodysplastic Syndrome Evolving Into Chronic Myelogenous Leukemia. J Clin Oncol 2011; 29:e434-6. [DOI: 10.1200/jco.2010.31.6265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ling Zhang
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Xiaohui Zhang
- University of South Florida College of Medicine, Tampa, FL
| | - Lynn Moscinski
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Alan F. List
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Rami Komrokji
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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8
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Shah N, Leaker MT, Teshima I, Baruchel S, Abdelhaleem M, Ye CC. Late-appearing Philadelphia chromosome in childhood acute myeloid leukemia. Pediatr Blood Cancer 2008; 50:1052-3. [PMID: 18213712 DOI: 10.1002/pbc.21317] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 3-year-old female was diagnosed with acute myeloid leukemia (AML-M2). The disease was refractory to various chemotherapeutic agents. Cytogenetic analysis revealed a clone with trisomy 8 at diagnosis that was replaced by a clone containing a t(11;15) and del(20q) by the end of the second induction. A new clone, characterized by a Philadelphia chromosome, with the minor BCR/ABL p190 transcript, emerged 14 months after diagnosis and remained to the end of disease course. The late occurrence of the Philadelphia chromosome in AML has been documented rarely in adults.
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Affiliation(s)
- Niketa Shah
- Department of Paediatrics, Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Nakase K, Yamamoto Y, Morita K, Yamaguchi T, Nishii K, Shiku H. Haunting appearance of bcr/abl fusion gene products in a patient with therapy related leukaemia. Leuk Res 2006; 30:106-8. [PMID: 15996731 DOI: 10.1016/j.leukres.2005.05.011] [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: 05/12/2005] [Accepted: 05/22/2005] [Indexed: 10/25/2022]
Abstract
A 81-year-old man was diagnosed as multiple myeloma and had received melphalan for 6 years. After that, he developed acute myeloid leukemia (AML) with monosomy 7 and minor bcr/abl transcripts. Fluorescence in situ hybridization identified no detectable level of bcr/abl rearrangement. During chemotherapy for AML, minor bcr/abl transcripts disappeared and instead major bcr/abl transcripts emerged. He died of pneumonia 3 months later. At that time, neither minor nor major bcr/abl transcripts were seen. These observations suggest that certain therapy related leukemia may be susceptible to generate very small clones with bcr/abl rearrangements.
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MESH Headings
- Aged, 80 and over
- Chromosomes, Human, Pair 7/metabolism
- Fatal Outcome
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Male
- Monosomy/physiopathology
- Multiple Myeloma/complications
- Multiple Myeloma/drug therapy
- Multiple Myeloma/metabolism
- Neoplasms, Second Primary/complications
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/metabolism
- Pneumonia/etiology
- Pneumonia/metabolism
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Affiliation(s)
- Kazunori Nakase
- The Second Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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10
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Keung YK, Beaty M, Powell BL, Molnar I, Buss D, Pettenati M. Philadelphia chromosome positive myelodysplastic syndrome and acute myeloid leukemia—retrospective study and review of literature. Leuk Res 2004; 28:579-86. [PMID: 15120934 DOI: 10.1016/j.leukres.2003.10.027] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2003] [Accepted: 10/21/2003] [Indexed: 10/26/2022]
Abstract
We conducted a retrospective study to define the significance of Philadelphia chromosome (Ph) in myelodysplastic syndrome and acute leukemia in the adults at this institution and the literature was reviewed. One hundred forty-eight cases of t(9;22)(q34;q11) were identified for the period September 1993 through August 2001. The presentation of 124 cases (84%) was that of typical CML in chronic phase. Nineteen cases (13%) presented as de novo ALL, two cases (1%) presented as de novo AML and three cases (2%) presented as myelodysplastic syndrome (MDS). The estimated incidences of t(9;22)(q34;q11) in ALL and AML are 21 and 0.6%, respectively. Ph+ AMLs are increasingly being reported with either M-BCR or m-BCR gene rearrangements, similar to those found with Ph+ ALL lending support to the notion that Ph+ AMLs are distinct entities and not merely blastic phases of undiagnosed CML. This is further supported by the existence of Ph+ MDS cases.
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MESH Headings
- Acute Disease
- Aged
- Anemia, Refractory/genetics
- Anemia, Refractory/pathology
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 9/genetics
- DNA, Neoplasm/genetics
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Male
- Middle Aged
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Retrospective Studies
- Translocation, Genetic
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Affiliation(s)
- Yi-Kong Keung
- Department of Internal Medicine, Comprehensive Cancer Center of Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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11
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Advani AS. Philadelphia chromosome positive myelodysplastic syndrome and acute myelogenous leukemia. Leuk Res 2004; 28:545-6. [PMID: 15120928 DOI: 10.1016/j.leukres.2003.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
MESH Headings
- Acute Disease
- Anemia, Refractory/genetics
- Anemia, Refractory/pathology
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 9/genetics
- DNA, Neoplasm/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Translocation, Genetic
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12
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Prebet T, Michallet AS, Charrin C, Hayette S, Magaud JP, Thiébaut A, Michallet M, Nicolini FE. Secondary Philadelphia chromosome after non-myeloablative peripheral blood stem cell transplantation for a myelodysplastic syndrome in transformation. Bone Marrow Transplant 2004; 33:247-9. [PMID: 14716291 DOI: 10.1038/sj.bmt.1704308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Dalla Torre CA, de Martino Lee ML, Yoshimoto M, Lopes LF, Melo LN, Caminada de Toledo SR, Duffles Andrade JA. Myelodysplastic syndrome in childhood: report of two cases with deletion of chromosome 4 and the Philadelphia chromosome. Leuk Res 2002; 26:533-8. [PMID: 12007500 DOI: 10.1016/s0145-2126(01)00152-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report two pediatric patients with unclassified myelodysplastic syndrome (MDS) by the French-American-British (FAB) group. Both cases had clinical and hematological peculiarities, which had not been described yet. The cytogenetic alterations were 4q deletion and the Philadelphia (Ph) chromosome which appeared at different moments of the disease. One patient showed the Ph chromosome at disease transformation and the other at diagnosis. The different breakpoints at 4q and the presence of Ph could be a marker of this form of MDS. The association of clinical and hematological findings suggests the possibility of a new group of pediatric MDS.
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Affiliation(s)
- Cristiane Arruda Dalla Torre
- Discipline of Genetics, Department of Morphology, Universidade Federal de São Paulo UNIFESP/EPM, 740, 04023-900 São Paulo, SP, Rua Botucata, Brazil
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14
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Wakayama T, Maniwa Y, Ago H, Kakazu N, Abe T. A variant form of myelodysplastic syndrome with Ph- minor-BCR/ABL transcript. Int J Hematol 2001; 74:58-63. [PMID: 11530806 DOI: 10.1007/bf02982550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study concerns a patient with minor (m)-BCR/ABL transcript-positive and Philadelphia (Ph) chromosome-negative myelodysplastic syndrome (MDS). The patient was a 78-year-old man whose condition was diagnosed as refractory anemia with excess of blasts in transformation. Molecular genetic studies, using reverse transcriptase polymerase chain reaction analysis detected m-BCR/ABL messenger RNA. We used spectral karyotyping to analyze metaphase cells but could not detect a Ph chromosome. Fluorescence in situ hybridization, however, revealed fusion signals of BCR and ABL probes on an apparently normal chromosome 22.
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MESH Headings
- Aged
- Anemia, Refractory, with Excess of Blasts/blood
- Anemia, Refractory, with Excess of Blasts/classification
- Anemia, Refractory, with Excess of Blasts/diagnosis
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/pathology
- Bone Marrow/pathology
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/ultrastructure
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 9/genetics
- Fatal Outcome
- Fusion Proteins, bcr-abl/genetics
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Karyotyping
- Male
- RNA, Messenger/genetics
- RNA, Messenger/isolation & purification
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
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Affiliation(s)
- T Wakayama
- Department of Hematology and Oncology, Shimane Prefectural Central Hospital, Izumo, Japan.
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15
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Abstract
Cytogenetic changes in primary myelodysplastic syndromes (MDS) have been extremely useful to identify clonality and to define specific clinico-pathological entities. More recently, with the development of DNA technology, a bulk of new information has been added to classical cytogenetics. Genes corresponding to chromosomal breakpoints implicated in reciprocal translocations have been cloned. Search for the minimal lost region has been the aim of the so-called deletion mapping approach to pick up the hypothetical suppressor gene(s) critical for typical deletions of MDS. Correlation has been found between gene mutations, deletions, expression, and clinical-hematological or cytogenetic features of MDS. Integration of fluorescence in situ hybridization at DNA level and of immunophenotyping at cellular level is an elegant tool to investigate clonal affiliation in MDS with distinct genetic changes.
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Affiliation(s)
- C Mecucci
- Hematology and Bone Marrow Transplantation Unit, University of Perugia, Policlinico Monteluce, Italy.
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