Correlation of clinical findings with quinacrine-banded chromosomes in 90 adults with acute nonlymphocytic leukemia: an eight-year study (1970-1977)

Two effects of GATA2 enhancer repositioning by 3q chromosomal rearrangements

Chromosomal inversion and translocation between 3q21 and 3q26 [inv (3)(q21.3q26.2) and t(3;3)(q21.3;q26.2), respectively] give rise to acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), which have poor prognoses. The chromosomal rearrangements reposition a GATA2 distal hematopoietic enhancer from the original 3q21 locus to the EVI1 (also known as MECOM) locus on 3q26. Therefore, the GATA2 enhancer from one of two GATA2 alleles drives EVI1 gene expression in hematopoietic stem and progenitor cells, which promotes the accumulation of abnormal progenitors and induces leukemogenesis. On the other hand, one allele of the GATA2 gene loses its enhancer, which results in reduced GATA2 expression. The GATA2 gene encodes a transcription factor critical for the generation and maintenance of hematopoietic stem and progenitor cells. GATA2 haploinsufficiency has been known to cause immunodeficiency and myeloid leukemia. Notably, reduced GATA2 expression suppresses the differentiation but promotes the proliferation of EVI1-expressing leukemic cells, which accelerates EVI1-driven leukemogenesis. A series of studies have shown that the GATA2 enhancer repositioning caused by the chromosomal rearrangements between 3q21 and 3q26 provokes misexpression of both the EVI1 and GATA2 genes and that these two effects coordinately elicit high-risk leukemia.

Acute Myeloblastic Leukemia after Adjuvant Chemotherapy with Melphalan in Breast Cancer. Case Report with Cytogenetic Analysis

Therapy of solid and hematologic tumors with alkylating agents appears to increase the frequency of acute non-lymphocytic leukemia (ANLL), as indicated by the cases reported in the literature. The carcinogenetic mechanism of alkylating agents seems related to their ability to damage DNA, and this is supported by the findings of multiple cytogenetic abnormalities in these patients. We report a case of ANLL secondary to therapy with melphalan, which was utilized on an adjuvant basis for breast cancer. ANLL developed 24 months after chemotherapy was discontinued. Results of the cytogenetic analysis in our patient showed multiple rearrangements and marker chromosomes. Among these was a large metacentric chromosome, identified in 6 of 8 karyotypes, in the size range of group A, which probably resulted from a translocation t(7;14) (7qter→7p11::14p11-→14qter). The natural history of the underlying disease and of the ANLL in our patient and data from chromosomal analysis seem to confirm the hypothesis that alkylating agents are potentially leukemogenic in man, probably through genetic damage. This possibility should be considered when such cytotoxic drugs are used in an adjuvant setting.

Genome sequencing and cancer

New technologies for DNA sequencing, coupled with advanced analytical approaches, are now providing unprecedented speed and precision in decoding human genomes. This combination of technology and analysis, when applied to the study of cancer genomes, is revealing specific and novel information about the fundamental genetic mechanisms that underlie cancer's development and progression. This review outlines the history of the past several years of development in this realm, and discusses the current and future applications that will further elucidate cancer's genomic causes.

t(8;21;8)(p23;q22;q22): a new variant form of t(8;21) translocation in acute myeloblastic leukemia with maturation

The complex variants of t(8;21) involving chromosomes 8 and 21 as well as a variable chromosome account for 1.1-5% of acute myeloid leukemia (AML) patients. This paper reports a case of AML-M2 with t(8;21;8) translocation for the first time. The patient was a female, aged 47 years. Her myelogram was compatible with AML-M2. Chromosome study using R-banding technique revealed a karyotype 46, XX, t(8;8)(p23;q22). Dual-color FISH assay with two probes P1 164(green signal) and YAC 225B8 (red signal) both of which closely located on the 8q showed that one yellow signal consisting of a green signal and a red signal and one red signal appeared on the long and the short arm of the same der(8) chromosome, respectively, further confirming this translocation occurred between both homologous chromosomes 8. RT-PCR analysis detected the AML1/ETO fusion transcript in our patient, thus indicating that this chromosomal aberration was, in fact, a complex three-way rearrangement t(8;21;8)(p23;q22;q22). In conclusion, combining conventional karyotype, FISH or RT-PCR analyses is a rational strategy for identification of the complex variants of t(8;21) translocation.

Variant t(8;21) rearrangements in acute myeloblastic leukemia of childhood

In a collaborative cytogenetic analysis of blast cells from 638 children with acute myeloid leukemia, 74 (11.6%) of the patients had the typical t(8;21)(q22;q22), while seven (1.1%) had complex variant translocations also involving 8q22 and 21q22 as well as a variable chromosome. In each case with a complex rearrangement, the myeloid leukemic cells contained Auer rods and were classified as M2 in the French-American-British (FAB) system. These seven children had a median age of 14 years (range, 7.3-18.9 years), a median initial leukocyte count of 9.1 x 10(9)/L (range, 2.5-142.2 x 10(9)/L), and have survived leukemia free for a median of 23 months (1-41 months) after attaining complete remission. The variable chromosomes in these seven cases--1, 2, 7, 12, 13, 15, and 17--appeared to be randomly involved. The clinico-biologic features of our cases with a variant t(8;21) are consistent with those of the published cases with the standard t(8;21), and support the hypothesis that the critical genetic alteration produced by the t(8;21) is located on the derivative 8.

Trisomy 13 in acute leukemia

Trisomy 13 occurring as a sole cytogenetic abnormality has recently been demonstrated to have adverse prognostic significance in acute leukemia. Trisomy 13 is seen primarily in an older male population, and has been reported in treatment-associated acute leukemia and acute leukemia evolved from myelodysplastic syndromes, as well as in de novo leukemia. The 36 cases of acute leukemia with trisomy 13 reported to date include 26 AML, 6 AUL, 2 ALL and 2 mixed lineage patients. Immunophenotyping studies have demonstrated an undifferentiated phenotype or biphenotypic markers in most cases. Trisomy 13 is associated with a low complete remission rate and with brief remission duration. The role of the additional copy of chromosome 13 in the pathogenesis of these cases of acute leukemia and the gene(s) of importance on chromosome 13 are yet to be determined.

Trisomy 13: a preferentially male chromosome aberration interfering specifically with myeloid proliferation and differentiation? Report of a case and review of the literature

A case of trisomy 13 is presented: a 73-year-old man with acute nonlymphocytic leukemia (ANLL), FAB borderline M1/M2, and peripheral leukocyte and platelet counts that were difficult to control with chemotherapy. A literature review shows that 35 cases of trisomy 13 are known at present. They are characterized by male predominance (76%), preferentially myeloid disorders (ANLL, myelodysplastic syndromes, chronic myeloid leukemia), leucocytosis, and relatively high platelet counts and hemoglobins. It is suggested that trisomy 13 is a specific nosologic entity with male predominance and characterized by interference with proliferation and differentiation in the myeloid differentiation series.

Trisomy 13 as a primary chromosome aberration in acute leukemia

Four patients with acute leukemia displayed trisomy 13 as the primary chromosome abnormality. The two patients with acute nonlymphocytic leukemia FAB-type M1 (ANLL-M1) had the karyotypes 47,XY,+13/48,XY,+13,+13 and 47,XX,+13, a patient with the hypogranular form of ANLL M3 had 47,XX,+13, and the fourth patient, who had acute undifferentiated leukemia (AUL), had the karyotype 47,XY,+13/48,XY,+8,+13. Including these four cases, a total of 24 hematologic neoplasms with an extra chromosome 13 as the sole aberration have now been reported. Except for the AUL, all have been of myeloid origin--20 ANLL, one myelodysplastic syndrome, and two chronic myeloproliferative disorders. Trisomy 13 as the sole acquired karyotypic abnormality therefore seems to be strongly associated with myeloid differentiation of the neoplastic cells and with a differentiation block leading to acute leukemia.

Involvement of bands 9q21-q22 in five cases of acute nonlymphocytic leukemia

Five patients with acute nonlymphocytic leukemia (ANLL) with chromosomal aberrations involving bands 9q21-q22 are described. The abnormalities were an interstitial deletion in two cases of ANLL FAB type M4 and M4 with eosinophilia, a terminal deletion in two cases of M4 and M5 type ANLL, and a translocation in an M2 ANLL. A review of reported cases of ANLL with abnormalities of chromosome 9 revealed a clustering of breaks at the region 9q21-q22, suggesting a possible role for these bands in leukemogenesis.

Trisomy 5 as sole anomaly in acute lymphoblastic leukemia

We present a case of B-cell acute lymphoblastic leukemia (ALL) in whose leukemic cells trisomy 5 (+5) was the only cytogenetic anomaly observed. This is the first report of +5 as the sole cytogenetic abnormality in ALL; two cases (one questionable) of acute nonlymphocytic leukemia with such a change have been reported. The findings are presented in relation to other cases with +5 as part of a more complicated cytogenetic picture in hematologic disorders.

Translocation (8;21) and its variants in acute nonlymphocytic leukemia. The relative importance of chromosomes 8 and 21 to the genesis of the disease

Chromosome analysis was performed in 25 patients with acute nonlymphocytic leukemia (ANLL), mostly of the M2 type. Eighteen had the standard translocation, t(8;21)(q22;q22), four had complex translocations involving 1p36, 11p13, 17p11, and 17p23, respectively, with chromosomes 8 and 21, and the remaining three patients had simple translocations, one with t(3;21)(p14;q22) and two with t(16;21)(p11;q22), without involving chromosome 8. Chromosome abnormalities additional to t(8;21) and its variants that were most frequently observed were -X, -Y, and del(9). Complex translocations are thought to be derived from the standard translocation and to be essentially similar in nature. The finding that chromosome 21 was involved in all of the standard, simple, and complex translocations, and that chromosome 8 was not involved in simple variants suggest a greater weight of chromosome 21 in the relative importance of the two chromosomes to the genesis of ANLL.

Cytogenetic investigations on children with acute non-lymphocytic leukemia

Cytogenetic data from 30 children with acute non-lymphocytic leukemia (ANLL) are evaluated in connection with patient's age, morphological type of leukemia and prognosis. In 20 out of 30 patients clonal chromosome aberrations were found. The frequency of chromosome aberrations and the prognostic parameters in the various morphological and age groups proved to be different and no direct relationship could be found in a given group between the frequency of aberrations and the prognosis. A more detailed analysis of data, however, provided some evidence that chromosome aberrations observed at diagnosis had a prognostic value independent of age and the morphological properties of blast cells: the normal karyotype and the pseudodiploidy proved to be of a favorable value but the hyperdiploidy and polyploidy an unfavorable prognostic parameter. Besides the known cytogenetic differences between childhood and adult ANLL, some similarities are also emphasized.

Inversion of chromosome 5 long arm in region of cell growth gene cluster in hematologic disorders

Inversions of the long (q) arm of chromosome #5 are reported in five cases with hematologic disorders. Inversion of 5q with breakpoints in bands 5q13 and 5q33 was found in two cases with lymphoid malignancy and in two cases of myeloid hematologic malignancy. Because an inversion of 5q with breakpoints in 5q22 and 5q33 was also found in a case with myeloproliferative syndrome, the common denominator in these five cases was band 5q33. An extraordinary cluster of genes affecting cell growth and differentiation is present on 5q and may be altered by the chromosome rearrangement of 5q in hematologic disorders.

Karyotypic analysis of the human monoblastic cell line U937

Karyotypes of three sublines of the human cell line U937 showed considerable variation, but all contained four consistent marker chromosomes (i.e., 3q-, 11q-, 16p+, and 17p- chromosomes). The 11q- chromosome appeared to be derived from either an interstitial deletion in bands 11q21-23 or from a translocation with an unidentified chromosome. The presence of this chromosome was of particular interest because rearrangements of chromosome #11 at band 11q23 are often associated with malignancies of the monocytic lineage. The possible significance of these findings is discussed.

Acute leukemia of megakaryocyte lineage with tumor formation. An autopsy case of patient with Down's syndrome

In this report we present the autopsy findings of acute megakaryoblastic leukemia with tumor formation in a 2-year-old female infant with Down's syndrome. Chromosomal analysis of blast cells revealed constitutional anomaly of trisomy 21 and two other related types of abnormal clones. Flow cytometric examination revealed blast cells expressing Ia-like or HLA-DR antigens. Postmortem examination showed extensive infiltration of leukemic cells in most of the examined organs, including the bone marrow with myelofibrosis. Tumor masses in the maxillary, frontal and femoral bones and the atria of the heart had undergone massive infiltration of atypical blast cells with an increase in the reticulin network. The final diagnosis was confirmed by ultrastructural cytochemistry of the platelet peroxidase reaction as well as by immunological staining utilizing anti-platelet glycoprotein IIb/IIIa, antiplatelet factor 4 and anti-beta-thromboglobulin antibodies for the blast cells. It seems likely that platelet-derived growth factor, secondary to an increase in the reticulin network, plays a major role in myelofibrosis of acute megakaryoblastic leukemia with tumor formation.

Translocations and deletions with breakpoint on 21q are nonrandomly associated with treatment-related acute nonlymphocytic leukemia and preleukemia

Six of 70 (8.6%) consecutive cases with therapy-related acute nonlymphocytic leukemia (ANLL) or preleukemia had a translocation or deletion with a breakpoint on 21q. Such aberrations were seen in only one of 200 (0.5%) consecutive cases of de novo ANLL examined at our laboratory. The figures reflect a 17.1-fold increased incidence of 21q aberrations in therapy-related ANLL or preleukemia, compared with ANLL de novo. The difference is highly significant (p = 0.003). The increased incidence of 21q aberrations in therapy-related myelodysplastic syndromes was confirmed by literature studies. Band 21q22 was most often involved. Cases with t(8;21), which is strongly associated with the M2 variant of ANLL, or cases with i(21q), which is supposedly due to a centromeric misdivision, were not included in the count. It is concluded that the 21q aberrations are associated with treatment-related ANLL or preleukemia with at least the same degree of specificity as aberrations of #5 and #7.

Prognostic significance of chromosomal abnormalities in acute nonlymphocytic leukemia: a study of 343 patients

Clonal chromosome abnormalities of 343 patients with de novo acute nonlymphocytic leukemia (ANLL) have been tentatively correlated with prognosis. All the patients were treated according to therapeutic protocols in the same hospital. The complete remission rate and median survival were generally lower in AA-ANLL (ANLL with only karyotypically abnormal metaphases) when compared with NN- and AN-ANLL. Similarly, AA-ANLL had the poorest prognosis in the majority of the classes of the French-American-British nomenclature. ANLL with inversion and/or deletion of chromosome #16 had the best prognosis, and ANLL with t(8;21) was not particularly favorable, nor was acute promyelocytic leukemia with t(15;17). ANLL with complex chromosomal abnormalities had the poorest prognosis. The conclusion is that chromosomal aberrations do have a prognostic significance in ANLL, but that this significance is dependent on the types of chromosomal aberrations.

The role of intensive remission induction and consolidation therapy in patients with acute myeloid leukaemia

Sixty-one patients with AML, 59 adults and two children, were treated with intensive remission induction and consolidation therapy. The median age was 36 years. Forty-four (72%) patients entered complete remission (CR); 11 patients received a bone marrow transplantation. The median survival of complete remitters was 26.5 months; the probability of remaining in CR at respectively 1 and 2 years was 75% and 62%. The only factor significantly correlated with the outcome of remission induction, survival and duration of CR was age. Patients less than 30 years fared significantly better than those 30 years or older; no difference in outcome was observed between patients aged 30-50 and those over 50 years. In patients less than 30 years the CR rate was 95%; 75% of them were still alive at 2 years and only one (5%) has relapsed. In contrast, in patients 30 years or older the CR rate was 60% and the median survival only 11.5 months, 50% of the complete remitters in this age group have relapsed. Morbidity from intensive consolidation therapy was considerable; more than 50% of consolidation courses were complicated by high fever, needing urgent admission; only four (3%) courses had a fatal event. It is concluded that intensive consolidation therapy may be considered as a major advance in the treatment of younger patients with AML, while its role in older individuals remains questionable. A possible explanation for the completely different outcome in younger and older patients with AML is discussed.

Toward a clinically relevant cytogenetic classification of acute myelogenous leukemia

Cytogenetic studies with Giemsa banding were performed on the bone marrow cells of 384 patients with acute myelogenous leukemia treated between 1975 and 1983. An abnormal karyotype was detected in 54% of patients, being present in 100% of metaphases (AA) in 31% and only a proportion of cells (AN) in 22%. Specific translocations or other abnormalities were noted in 22% of patients, the most common of which were t(8;21) (q22;q22) in 7%, t(15;17) (q22;q21) and inv (16) (p13q22) in 5.5%, t(9;22) (q34;q11) in 3% and abnormalities of 11q23 in 1.3%. Loss of the Y chromosome was noted in 21 patients, associated with t(8;21) in 11 patients and the sole abnormality in eight patients (45, X, -Y). Most (66%) of the other abnormalities involved addition of chromosome 8 or loss or deletion of 5 or 7 (+8, -5 or -7, 5q- or 7q- group). The remaining patients had miscellaneous abnormalities (MA). A marked assymetry was noted in the distribution of important clinical prognostic variables such as age, sex, history of an antecedent hematologic disorder and presence of Auer rods within the various cytogenetic categories. The specific translocation/abnormalities were more common in younger patients (p less than 0.01). Analysis of response, remission duration and survival demonstrated that inv 16 and t(8;21) were favorable prognostic categories; diploid, t(15;17) and 45,X,-Y had intermediate prognosis, and all other categories were unfavorable prognostic groups. The response rate and survival for diploid patients (NN) was superior to patients with abnormalities. No difference in response rate, CR duration or survival was noted between the AA and AN groups. A prognostic classification according to cytogenetic category based on clinical associations is proposed which will be tested prospectively in subsequent studies.

Multiparameter characterization of L3 leukemia cell populations

Multiparameter analysis of 14 consecutive patients with L3 cell populations (FAB classification) in bone marrow showed consistently high mean cellular RNA content but heterogeneity with respect to percent cels in S- and G2M-phases of the cell cycle, cell surface phenotype, cytogenetic abnormalities, cellular DNA content, and nuclear activities of terminal deoxynucleotidyl transferase. Five of the 14 patients had the characteristic profile of L3 leukemia with high RNA content, a typical t(8;14) or t(8;22) translocation, low Tdt, B-cell surface phenotype, pseudodiploid modal number of chromosomes, high proliferation and normal DNA index. The remaining 9 patients had features thought to be unusual and they were very heterogeneous. Median survival time from time of diagnosis was 115 days with no patient alive after 474 days. The survival times exhibited excellent correlation with a parametric model assuming exponential distribution. Accordingly, the presence of abnormal DI predicted for decreased, and the presence of t(8;14) or pseudodiploidy was associated with increased survival rates. However, due to the small number of patients in this study, generally applicable conclusions should be drawn only from a collection of larger numbers of cases of this rare type of leukemia.

Simple monosomy 7 and myelodysplastic syndrome in thirteen patients without previous cytostatic treatment

Thirteen patients with simple monosomy 7 presented with pallor in 11, easy bruisability in five, splenomegaly in four, no infections, refractory anaemia in all, granulocytopenia in seven, monocytosis in three, leucocytosis in four and thrombocytopenia in eight. Peripheral blood and bone marrow findings were consistent with myelodysplastic syndrome (MDS) type I in three, type II in two, type III in two, type IV in three and acute myelofibrosis in three patients. Transformations to acute leukaemia in seven patients were M2 in one, M4 in four, megakaryoblastic in one and undifferentiated in one. Lack of chromosome 7 in 12-85% of analysed cells at initial presentation of MDS progressed to nearly 100% during blastic transformation. At that time an additional change in the long arm of chromosome 3 was seen in two patients and trisomy 8 in 6% of analysed cells in a third case. The median survival time was 12 months for MDS and 3 months for acute leukaemia. Simple monosomy 7 appears to be largely confined to young children and elderly people.

New variant translocation (1;8;21) in a case of acute myeloblastic leukemia (M2)

A new translocation involving chromosome #1, #8, and #21 in a patient with type M2 acute myeloblastic leukemia is reported. The breakpoint of #1 in this case was at band p13 and differed from that in two previously reported cases of t(1;8;21) involving the long arm of #1. A key event leading to the development of the M2 phenotype appears to be a break at band q22 of #8 with associated translocation of the terminal end of the long arm of #21.

Genetics and cytogenetics of pediatric cancers

It is clear that genetic factors play an important role in the development of some human cancers. These factors may be particularly influential in the pediatric age group because environmental exposures have been minimal. Several pediatric solid tumors, including retinoblastoma and Wilms' tumor, are hereditary. Specific constitutional chromosome abnormalities have been found in these patients, thus implicating certain gene regions as being involved in tumorigenesis. Molecular genetic studies have provided insight into the events occurring at the DNA level in these gene regions. The role of genetics in the development of sporadic pediatric malignancies is also beginning to be elucidated as specific acquired chromosome abnormalities are being discovered in the malignant cells of these otherwise karyotypically normal individuals. This paper will review selected hereditary and nonhereditary pediatric cancers that demonstrate the importance of genetic considerations in the diagnosis and management of children with cancer.

DNA aneuploidies in adult patients with acute myeloid leukemia. Incidence and relation to patient characteristics and morphologic subtypes

Analyses of the cellular DNA content were carried out by flow cytometry (FCM) in 148 adult patients with acute myeloid leukemia (AML) to assess the incidence of DNA aneuploidies and its relation to patient characteristics and morphologic subtypes. DNA aneuploidies were found in 54 of 131 patients with de novo AML (41.2%) and in 4 of 17 patients with AML after preleukemic syndromes. Subclassification according to morphology revealed the lowest rate of DNA aneuploidies in M1 leukemias (25%) and a significantly lower degree of DNA aneuploidy in M1 and M2 cases as compared to M4 and M5 subtypes (P less than 0.05). Within the group of M4 and M5 leukemias, patients less than or equal to 40 years of age had a higher frequency of aneuploid DNA stemlines (71.4%) than older patients (33.3%) (P less than 0.025). No differences between patients with and without DNA aneuploidy were identified for the initial leukocyte count, serum LDH, bone marrow S-phase index, bone marrow cell count/mm3 bone marrow nor the initial response to the induction regimen of 6-thioguanine, cytosine arabinoside, and daunorubicin (TAD). For remission duration a tendency towards a higher proportion of lung remissions was observed in patients with DNA aneuploidy.

Complex translocation t(3;9;22) and paracentric inversion of chromosome 3 in blastic crisis of chronic myeloid leukemia

We report a complex rearrangement observed in both the short and long arms of chromosome #3 in a patient with Ph-positive chronic myeloid leukemia in blastic crisis and without thrombopoietic abnormalities. The rearrangement consisted of a complex translocation, t(3;9;22)(p21;q34;q11), and a paracentric inversion of the long arm of the same chromosome #3 involved in the translocation. Involvement of chromosome #3 in complex translocations in chronic myeloid leukemia and the relationship between 3q anomalies and thrombopoietic diseases are discussed.

Predictors of response of acute nonlymphocytic leukemia

Given the time and effort expended by investigators and given the large numbers of patients studied, there are disappointingly few "predictors" of response. From the clinical perspective, aside from performance status, age, prior history of toxic exposure, and grossly abnormal organ function, there are essentially no reliable indicators of the likelihood of a patient surviving remission induction therapy. The absence of such indicators might reflect the fact that without grossly abnormal organ function, all patients generally begin with an equal possibility of survival and that events which occur during therapy determine survival. One thing is certain, death directly attributable to leukemic cell overgrowth despite chemotherapy is an extremely rare event. Hence, therapeutic inadequacy in this sense, at the time of initial diagnosis, is not a common cause of treatment failure. Studies aimed at the prediction of leukemic cell responsiveness to therapy have been plagued by two general problems. The first is that the drug sensitivity assays have been quite primitive. For example, the ability of a cell to take up a drug is not synonymous with sensitivity to that drug. Additionally, tests which are dependent upon assays capable of making measurements in only a small subpopulation of cells, such as in vitro clonogenic assays, are likely to have only limited applicability. On the other hand, assays which measure the properties of the leukemic cell population as a whole are incapable of recognizing arabinoside therapy have provided data which suggest that in addition to patient survival three conditions must be satisfied if a complete remission is to occur: the pretherapy leukemic cell mass must be moderate or low, an adequate number of cells must be synthesizing DNA, and cytosine arabinoside must produce significant inhibition of DNA synthesis in vitro. Each factor is consistent with what is known about cytosine arabinoside: it is an S-phase-specific agent which must be incorporated into DNA in order to kill leukemic cells. When the relationship between these same factors and response to combination chemotherapy were studied, not unexpectedly, no relationship was discerned. Finally, in this setting pharmacokinetic studies have demonstrated that the amount of araCTP formed in leukemic cells in vivo when doses of 2 g and 3 g/m2 are administered are indistinguishable, thereby explaining the clinical equivalence of these two dosage levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormal/normal metaphase ratio and prognosis in chronic B-lymphocytic leukemia

Cytogenetic analysis was performed in B-cell mitogen-stimulated leukemic cell cultures from 55 patients with chronic B-lymphocytic leukemia. Clonal chromosomal aberrations were found in the cells of 33 patients, whereas 10 patients were cytogenetically normal. For 12 patients, too few metaphases were found to enable proper evaluation of the karyotype. The patients were subdivided into four groups according to the ratio between the number of metaphases with abnormal and normal chromosome patterns: AA, patients with only abnormal (A) metaphases; A/N high, patients with both abnormal and normal (NN metaphases and an A/N ratio greater than 0.5; A/N low, patients with an A/N ratio less than 0.5; NN, patients with only normal metaphases. In a log rank analysis, increasing A/N ratio was significantly associated with poor survival (p = 0.025). Four AA patients had a median survival of 6 months, whereas the 5-year probability of survival was 0.62 for the A/N high group, 0.92 for the A/N low group, and 1.0 for the NN group.

Loss of the Y chromosome in acute myelogenous leukemia: a report of 13 patients

Thirteen male patients with acute myelogenous leukemia who, on bone marrow chromosome analysis, were missing all or part of the Y chromosome were treated at this institution between 1975 and 1983. Giemsa-banding techniques were performed in 12 cases. Twelve showed -Y in at least 80% of bone marrow metaphases, and one patient had 25% 46,XYqh-. The loss of the Y chromosome was the sole karyotypic abnormality in nine patients, and the remaining four had additional chromosome changes. The peripheral blood lymphocytes were diploid in all except three cases, where no mitotic cells were recovered. The median age was 55 years, eight patients had acute myelogenous leukemia (M2) and five acute myelomonocytic leukemia (M4). Six patients (46%) had an antecedent hematologic disorder. Eleven patients received standard induction combination chemotherapy. Complete remission was achieved in seven patients (63%). Remission bone marrow chromosome analysis showed 100% 46,XY in all seven cases. The median durations of complete remission and survival were 10 months and 12 months, respectively. The review suggests that -Y is a consistent, although uncommon, chromosome marker in acute myelogenous leukemia, associated with an aggressive clinical course and intermediate prognosis.

Persistent Epstein-Barr virus infection associated with monosomy 7 or chromosome 3 abnormality in childhood myeloproliferative disorders

This report deals with myeloproliferative disorders associated with chronic, persistent Epstein-Barr virus (EBV) infection and with monosomy 7 and aberrations concerning chromosomes 3 and 5. Altogether five children were affected, their age ranging from 1 to 4 years at time of clinical diagnosis. Principal symptoms were: hepatomegaly, splenomegaly, recurring upper respiratory tract infection and anaemia. The serum IgG level remained persistently increased. Anti EBV antibody concentrations were measured over a period of 9 months to 6 years, demonstrating persistently increased concentrations of IgG antibodies to viral capsid antigen (VCA) and against early antigen (EA). In three patients IgA antibodies were also studied and were found to be elevated. Within 2-5 years two children developed chronic myelomonocytic leukaemia from the chronic myeloproliferative syndrome. A third patient who initially was diagnosed as chronic myelomonocytic leukaemia developed acute leukaemia within a period of 12 months. A fourth patient with myeloproliferative syndrome went into spontaneous remission after an observation period of 2 years. A fifth patient, the only one with translocation t(3;5)(q27;q33), displayed symptoms and a clinical course that can best be characterized as juvenile chronic myelocytic leukaemia. The clinical, haematological, serological and cytogenetic findings may be related.

Acquisition of a Philadelphia chromosome concomitant with transformation of a refractory anemia into an acute leukemia

The authors present a case of Philadelphia (Ph1) positive acute myeloblastic leukemia (AML) following a refractory anemia with excess of blasts (RAEB) that had been Ph1-negative for 17 months. During the transformation of RAEB into AML, the Ph1 was discovered in 100% of the examined cells. With therapy a partial remission was obtained, during which some 46,XY cells reappeared mixed with Ph1 cells along with a new clone: 47,XY,+11 originating from a Ph1-negative cell. During the terminal blast crisis, the karyotype returned to 46,XY,Ph1. The AML lasted 21 months. The authors discuss: (1) the significance of Ph1-positive AML with a review of the literature; (2) the de novo acquisition of a Ph1 during the course of a blood disorder; and (3) the meaning of a second abnormal clone originating from 46,XY cells.

Translocation 2;11 and other significant chromosome changes in acute monoblastic leukemia (M5) with clonal evolution: sequential clinical and cytogenetic studies

An elderly woman presented with pancytopenia resulting from acute monoblastic leukemia (AMoL) type M5a. At the time of diagnosis, the marrow metaphase studies revealed a pseudodiploid idiogram: 46,XX,t(2;11)(q37;q23),(t(7;9;10)(q22;q22;p13). At relapse, 7 months later, a clonal derivative of the initial pseudodiploid pattern was identified. Though alterations of chromosome regions 7q22 and 9q22 are frequently seen in acute nonlymphocytic leukemia (ANLL), 11q structural anomalies are even more specific for this group of leukemias, and the involvement of band 11q23 is particularly striking in AMoL. Various chromosomes may take part in translocations with chromosome #11, but the participation of chromosome #2 as in this case is apparently rare.

Relationship between patients' age, bone marrow karyotype, and outcome of induction therapy in acute myelogenous leukemia

Bone marrow karyotypes were performed in 88 cases of adult acute myelogenous leukemia (AML) at diagnosis and classified NN (normal), AA (abnormal), and AN (mixture of normal and abnormal metaphases). A clear relationship was found between karyotype and complete remission (CR) rate: 58% CR in (NN + AN) cases; 14% CR in AA cases (P less than .009). This relationship was even stronger when only patients under 60 years of age were studied. Considering failures of induction treatment, no relationship was found between the NN/AN/AA classification and a drug resistance. In patients over 60, the worse prognosis could be explained by an inferior ability to tolerate intensive treatment.

Evidence for a 15;17 translocation in every patient with acute promyelocytic leukemia

Cytogenetic specimens were obtained from blood or bone marrow in 27 patients with acute promyelocytic leukemia, including four with the microgranular variant. A 15;17 translocation was identified in 21 to 100 percent of metaphase cells from all 27 patients. The structural rearrangement was identical in every case, and the breakpoints were assigned to 15q22 and 17q21.1. Twelve patients had complete remission, and two (both with the microgranular variant) have had unmaintained continuous remission longer than four years. These data indicate that the 15;17 translocation may be found in every patient with acute promyelocytic leukemia if optimal chromosome analysis is performed.

Adult acute nonlymphocytic leukemia

Chemotherapy of adults with acute nonlymphocytic leukemia has improved in recent years, yielding complete remissions in 65 per cent and cure in 10 to 15 per cent of all treated patients. Allogeneic bone marrow transplantation cures approximately one half of eligible young patients who gain an initial remission with chemotherapy. Autologous bone marrow transplantation may ultimately prove to be of value for the large numbers of patients who are over 40 years of age or who lack histocompatible siblings. Current investigative approaches in all these areas, based on insights into the pathophysiology of disease discussed in this article, should enhance the outcome for affected patients in the next decade.

A stage classification for prognosis in adult acute myelogenous leukaemia based upon patients' age, bone marrow karyotype and clinical features

In 71 adult acute myelogenous leukaemia (AML) cases, the relationship between well-known prognostic features and complete remission (CR) rate and survival was studied. These features were: (i) bone marrow karyotype classified NN, AN, AA according to Sakurai & Sandberg (5); (ii) patients' age; (iii) clinical 'negative prognostic features' (NPF): previous history of preleukaemia, septicaemia or pneumonia, hyperleucocytosis, associated pathology (diabetes, obesity, renal insufficiency etc.). 59 years of age was found to be a frontier between 2 homogeneous groups having quite different prognosis. The NN/AN/AA classification had good prognostic value (CR rate and survival) in patients under 59 years, but not in older patients. In those patients over 59, a significant difference in CR rate and survival appeared between cases with NPF and those without. For each feature having an established relationship to survival, a panel of prognostic points was determined as follows: age over 59 (1 point), AA karyotype in patients under 59 (2 points), NPF in patients over 59 (1 point). Using this stage classification, it was possible to classify every case into 1 of 3 groups (i.e.: 0 points, 1 point, 2 points). The life-table analysis of these 3 groups showed very significant differences. The median survival times were 18.5 months, 5.2 months and 1.3 month, for the 0-point group (26 cases), the 1-point group (19 cases) and the 2-point group (26 cases), respectively.

The relationship between growth in agar, karyotype and prognosis in acute leukaemia

The growth pattern in agar culture and the karyotype of bone marrow cells were studied in 79 patients with untreated acute non-lymphocytic leukaemia (ANLL). Results were divided into the following groups: (A) colony and cluster formation; (B) growth of less than 600 small clusters per 10(5) cells; (C) growth of more than 600 small clusters; (D) no growth in agar. Cytogenetically, the patients were divided into 3 categories: NN, normal metaphases only; AN, both abnormal and normal metaphases and AA, abnormal metaphases only. An association was seen between growth pattern and karyotype: the majority of NN patients (33/37) belonged to group (A + B) while in group (C + D) 20/24 patients were AN or AA. 37 patients were prognostically evaluable. The growth pattern in agar but not the cytogenetic pattern had prognostic implications. 25 patients with acute lymphocytic leukaemia (ALL) were also studied at diagnosis. Different growth patterns in agar had no impact on prognosis. No relationship was detected between growth pattern and karyotype in ALL.

Prognostic implications of in vitro colony studies and clonal chromosomal aberrations in adults with acute leukaemia

A comparison was made between in vitro colony culture parameters and chromosomal abnormalities in 44 adult patients with acute leukaemia, with special reference to prognosis. The presence of clonal chromosomal aberrations in some (AN) or all (AA) metaphases of bone marrow cells was a fairly strong indication of poor prognosis, while the absence of abnormal metaphases (NN) was a favourable prognostic sign. 6 of 7 patients in the NN group entered complete remission (CR), as did 8 of 20 in the AN + AA group and 8 of 17 in the group with random loss of chromosomes (NNA). The median survival time for AN + AA patients was 4 months, while for patients without clonal aberrations (NN + NNA) it was 9 months. Of the cultural parameters studied, colony-stimulating activity (CSA) of peripheral leucocytes had the strongest correlation to prognosis. CSA greater than 1 was related to remission (P less than 0.01) and longer survival (P less than 0.05 at 4 months), while 8 patients with CSA less than or equal to 1 were all dead at 8 months. However, very high CSA values (greater than 20) indicate a poor prognosis. Although both chromosome analysis and CSA were of prognostic value, combining the 2 parameters did not improve the prognostic information, mainly because of covariation of NN and CSA greater than 1.

Karyotypic evolution in patients with acute myeloid leukemia

Karyotypic evolution was found in 13 of 42 (31%) patients who were examined serially; if only those patients who were examined during successive stages of active leukemia were included, karyotypic evolution was revealed in 13 of 21 (62%). A further 6 patients showed multiple cytogenetic clones when leukemia was diagnosed. We did not find nonrandom chromosome involvement in the karyotypic changes, reported by others, notably trisomy #8. Our data for all patients who showed cytogenetic clones at some stage of their disease suggested that clones occurred with a higher incidence and arose earlier in patients with myeloblastic leukemia than in patients with myelomonocytic and monocytic leukemia. Patients showing karyotypic evolution tended to have longer than average survivals and to have had an abnormal karyotype when leukemia was diagnosed. The mode of preparation of hematologic samples, whether direct or cultured, has a bearing on karyotypic findings and could influence studies of karyotypic evolution.

A variant 8;21 translocation in acute myeloblastic leukemia

A three-way rearrangement involving chromosomes 1, 8, and 21 was observed in bone marrow cells from a female with acute myeloblastic leukemia, subtype M2 (AML-M2). The translocation break points in chromosomes 8 and 21 were identical to those found in the standard t(8;21) that is associated with this disease type. A review of this and four previously reported cases involving variant 8;21 translocations indicates that a consistent pattern of exchange may be involved in these complex rearrangements even though the third chromosome affected may differ.