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Kosik P, Skorvaga M, Durdik M, Jakl L, Nikitina E, Markova E, Kozics K, Horvathova E, Belyaev I. Low numbers of pre-leukemic fusion genes are frequently present in umbilical cord blood without affecting DNA damage response. Oncotarget 2018; 8:35824-35834. [PMID: 28415763 PMCID: PMC5482620 DOI: 10.18632/oncotarget.16211] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022] Open
Abstract
Despite widely accepted notion that many childhood leukemias are likely developed from hematopoietic stem/progenitor cells (HSPC) with pre-leukemic fusion genes (PFG) formed in embryonic/fetal development, the data on PFG incidence in newborns are contradictive. To provide a better understanding of a prenatal origin of leukemia, umbilical cord blood from 500 newborns was screened for the presence of the most frequent PFG associated with pediatric B-cell acute lymphoblastic leukemia. This screening revealed relatively high incidence of ETV6-RUNX1, BCR-ABL1 (p190) and MLL-AF4 at very low frequencies, averaging ~14 copies per 100,000 cells. We assume that most of these PFG might originate relatively late in embryonic/fetal development and will be eliminated later during postnatal development. The obtained results suggested that higher PFG copy numbers originating in specific time windows of the hematopoietic stem cell hierarchy may define a better prognostic tool for the assessment of leukemogenic potential. We have observed no significant effect of low-copy PFG on radiation-induced DNA damage response, accumulation of endogenous DNA double-stranded breaks, and apoptosis in either lymphocytes or HSPC. Imaging flow cytometry showed lower level of γH2AX foci in HSPC in comparison to lymphocytes suggesting better protection of HSPC from DNA damage.
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Affiliation(s)
- Pavol Kosik
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Milan Skorvaga
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Matus Durdik
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lukas Jakl
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Ekaterina Nikitina
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Eva Markova
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Katarina Kozics
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Eva Horvathova
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Igor Belyaev
- Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
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Corces MR, Chang HY, Majeti R. Preleukemic Hematopoietic Stem Cells in Human Acute Myeloid Leukemia. Front Oncol 2017; 7:263. [PMID: 29164062 PMCID: PMC5681525 DOI: 10.3389/fonc.2017.00263] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive malignancy of the bone marrow characterized by an uncontrolled proliferation of undifferentiated myeloid lineage cells. Decades of research have demonstrated that AML evolves from the sequential acquisition of genetic alterations within a single lineage of hematopoietic cells. More recently, the advent of high-throughput sequencing has enabled the identification of a premalignant phase of AML termed preleukemia. Multiple studies have demonstrated that AML can arise from the accumulation of mutations within hematopoietic stem cells (HSCs). These HSCs have been termed "preleukemic HSCs" as they represent the evolutionary ancestors of the leukemia. Through examination of the biological and clinical characteristics of these preleukemic HSCs, this review aims to shed light on some of the unexplored questions in the field. We note that some of the material discussed is speculative in nature and is presented in order to motivate future work.
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Affiliation(s)
- M. Ryan Corces
- Center for Personal Dynamic Regulomes, Stanford University School of Medicine, Stanford, CA, United States
- Program in Epithelial Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Howard Y. Chang
- Center for Personal Dynamic Regulomes, Stanford University School of Medicine, Stanford, CA, United States
- Program in Epithelial Biology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ravindra Majeti
- Program in Cancer Biology, Cancer Institute, Institute for Stem Cell Biology and Regenerative Medicine, Ludwig Center, Stanford University School of Medicine, Stanford, CA, United States
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3
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Corces-Zimmerman MR, Majeti R. Pre-leukemic evolution of hematopoietic stem cells: the importance of early mutations in leukemogenesis. Leukemia 2014; 28:2276-82. [PMID: 25005245 PMCID: PMC4262622 DOI: 10.1038/leu.2014.211] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/23/2014] [Indexed: 12/17/2022]
Abstract
Cancer has been shown to result from the sequential acquisition of genetic alterations in a single lineage of cells. In leukemia, increasing evidence has supported the idea that this accumulation of mutations occurs in self-renewing hematopoietic stem cells (HSCs). These HSCs containing some, but not all, leukemia-specific mutations have been termed as pre-leukemic. Multiple recent studies have sought to understand these pre-leukemic HSCs and determine to what extent they contribute to leukemogenesis. These studies have elucidated patterns in mutation acquisition in leukemia, demonstrated resistance of pre-leukemic cells to standard induction chemotherapy and identified these pre-leukemic cells as a putative reservoir for the generation of relapsed disease. When combined with decades of research on clonal evolution in leukemia, mouse models of leukemogenesis, and recent massively parallel sequencing-based studies of primary patient leukemia, studies of pre-leukemic HSCs begin to piece together the evolutionary puzzle of leukemogenesis. These results have broad implications for leukemia treatment, targeted therapies, minimal residual disease monitoring and early detection screening.
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Affiliation(s)
- M. Ryan Corces-Zimmerman
- Program in Cancer Biology, Cancer Institute, Institute for Stem Cell Biology and Regenerative Medicine, and Ludwig Center, Stanford, CA 94305, USA
| | - Ravindra Majeti
- Program in Cancer Biology, Cancer Institute, Institute for Stem Cell Biology and Regenerative Medicine, and Ludwig Center, Stanford, CA 94305, USA
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Stanford, CA 94305, USA
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4
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Zheng H, Wang X, Ma Y, Xu B, Chen S, Yang L, Wu X, Przybylski GK, Huang S, Ye T, Li Y. The TCR γδ repertoire and relative gene expression characteristics of T-ALL cases with biclonal malignant Vδ1 and Vδ2 T cells. DNA Cell Biol 2013; 33:49-56. [PMID: 24329526 DOI: 10.1089/dna.2013.2199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite significant improvement in our understanding of T-cell acute lymphoblastic leukemia (T-ALL) biology and pathogenesis, many questions remain unanswered. In previous studies, we found a T-ALL case with two malignant T-cell clones with Vδ1Dδ2Dδ3Jδ1 and Vδ2Dδ3Jδ2 rearrangements. In this study, we further characterized T-ALL cases with two malignant clones containing Vδ1Dδ3Jδ1 and Vδ2Dδ1Jδ1 rearrangements using fine-tiling array comparative genomic hybridization, ligation-mediated polymerase chain reaction (LM-PCR), sequencing, and reverse transcription polymerase chain reaction (RT-PCR) analysis. We further analyzed the distribution and clonality of the T-cell receptor (TCR) Vγ and Vδ subfamily T cells in the two T-ALL cases by RT-PCR and GeneScan. Monoclonal Vδ1 and Vδ2 subfamilies were confirmed in both samples, the Vδ3 through Vδ7 subfamilies could not be detected in the T-ALL samples, whereas the oligoclonal Vδ8 subfamily could be identified. Based on the clinical finding that both of the T-ALL cases with two malignant T-cell clones had a poor outcome, we attempted to compare the expression pattern of genes related to T-cell activation and proliferation between cases with the malignant Vδ1 and Vδ2 T-cell clones and T-ALL cases with a mono-malignant Vα T-cell clone. We selected two T-ALL cases with VαJα rearrangements and analyzed the expression level of Notch1, TAL1, and the CARMA-BCL10-MALT-A20-NF-κB pathway genes by real-time PCR. A20 had significantly higher expression in the biclonal compared with the monoclonal T-ALL group (p=0.0354), and there was a trend toward higher expression for the other genes in the biclonal group with the exception of TAL1, although the differences were not statistically significant. In conclusion, we identified two T-ALL cases with biclonal malignant T-cell clones and described the characteristics of the biclonal T-ALL subtype and its gene expression pattern. Thus, our findings may improve the understanding of biclonal T-ALL.
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Affiliation(s)
- Haitao Zheng
- 1 Institute of Hematology, Jinan University , Guangzhou, People's Republic of China
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Kotecha RS, Murch A, Kees U, Cole CH. Pre-natal, clonal origin of t(1;11)(p32;q23) acute lymphoblastic leukemia in monozygotic twins. Leuk Res 2012; 36:46-50. [DOI: 10.1016/j.leukres.2011.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 03/05/2011] [Accepted: 03/08/2011] [Indexed: 11/29/2022]
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Zuna J, Zaliova M, Muzikova K, Meyer C, Lizcova L, Zemanova Z, Brezinova J, Votava F, Marschalek R, Stary J, Trka J. Acute leukemias with ETV6/ABL1 (TEL/ABL) fusion: poor prognosis and prenatal origin. Genes Chromosomes Cancer 2010; 49:873-84. [PMID: 20589932 DOI: 10.1002/gcc.20796] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The ETV6/ABL1 (TEL/ABL) fusion gene is a rare aberration in malignant disorders. Only 19 cases of ETV6/ABL1-positive hematological malignancy have been published, diagnosed with chronic myeloid leukemia, other types of chronic myeloproliferative neoplasm, acute myeloid leukemia or acute lymphoblastic leukemia (ALL). This study reports three new cases (aged 8 months, 5 years, and 33 years) of ALL with the ETV6/ABL1 fusion found by screening 392 newly diagnosed ALL patients (335 children and 57 adults). A thorough review of the literature and an analysis of all published data, including the three new cases, suggest poor prognosis of ETV6/ABL1-positive acute leukemias. The course of the disease in the two pediatric patients is characterized by minimal residual disease monitoring, using quantification of both the ETV6/ABL1 transcript and immunoreceptor gene rearrangements. Eosinophilia could not be confirmed as a hallmark of the ETV6/ABL1-positive disease. Studies of neonatal blood spots demonstrated that, in the child diagnosed at five years, the ETV6/ABL1 fusion initiating the ALL originated prenatally.
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Affiliation(s)
- Jan Zuna
- Department of Pediatric Hematology and Oncology, CLIP (Childhood Leukaemia Investigation Prague), Charles University Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
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7
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Schmiegelow K, Vestergaard T, Nielsen SM, Hjalgrim H. Etiology of common childhood acute lymphoblastic leukemia: the adrenal hypothesis. Leukemia 2008; 22:2137-41. [PMID: 18719616 DOI: 10.1038/leu.2008.212] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The pattern of infections in the first years of life modulates our immune system, and a low incidence of infections has been linked to an increased risk of common childhood acute lymphoblastic leukemia (ALL). We here present a new interpretation of these observations--the adrenal hypothesis--that proposes that the risk of childhood ALL is reduced when early childhood infections induce qualitative and quantitative changes in the hypothalamus-pituitary-adrenal axis that increase plasma cortisol levels. This may directly eliminate leukemic cells as well as preleukemic cells for the ALL subsets that dominate in the first 5-7 years of life and may furthermore suppress the Th1-dominated proinflammatory response to infections, and thus lower the proliferative stress on pre-existing preleukemic cells.
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Affiliation(s)
- K Schmiegelow
- The Pediatric Clinic, The University Hospital Rigshospitalet, Copenhagen, Denmark.
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Infante-Rivard C, El-Zein M. Parental alcohol consumption and childhood cancers: a review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2007; 10:101-29. [PMID: 18074306 DOI: 10.1080/10937400601034597] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The etiology of childhood cancers remains generally unknown. Given that the metabolites of alcohol are likely carcinogens and that leukemia, the most frequent childhood cancer, can arise in utero, the study of alcohol consumption as a potential risk factor for the development of childhood cancer is justified. This article summarizes the epidemiological evidence on the association between parental exposure to alcohol and the risk of childhood cancers. To do this, a thorough search of the literature from 1960 to 2003 using the PubMed database was carried out. It yielded 33 case-control studies published between 1982 and 2003, including 13 studies that considered paternal exposure in the preconceptional period. In 10 of the 33 studies at least 1 statistically significant risk increase was reported in relation with parental alcohol consumption; in 7 of these studies the increase was related to maternal consumption, whereas in 3 studies, it was related to paternal consumption. The cancers most often found associated with parental drinking were leukemia, brain tumors, and neuroblastoma. A few studies also reported a protective effect with maternal exposure at modest levels. Inconsistencies in the results and the low risks reported do not suggest an association between childhood cancer and parental consumption of alcohol. However, before reaching any definitive conclusions, methodological issues need to be addressed in future studies, as well as the role of genetic susceptibility. Moreover, subtypes of specific cancers need to be studied separately.
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Affiliation(s)
- Claire Infante-Rivard
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
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Altieri A, Castro F, Bermejo JL, Hemminki K. Number of siblings and the risk of lymphoma, leukemia, and myeloma by histopathology. Cancer Epidemiol Biomarkers Prev 2006; 15:1281-6. [PMID: 16835324 DOI: 10.1158/1055-9965.epi-06-0087] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epidemiologic evidence indicates that several markers of exposure to childhood infections are inversely associated with the risk of childhood leukemia and lymphomas. We used the Swedish Family-Cancer Database to assess the effects of number of siblings on the risk of non-Hodgkin's (n = 7,007) and Hodgkin's lymphomas (n = 3,115), leukemias (n = 7,650), and multiple myeloma (n = 1,492) by histopathology. Poisson regression models included terms for age, sex, family history, period, and socioeconomic index. Having four or more siblings compared with none was associated with an excess risk of childhood acute lymphoblastic leukemia [ALL; rate ratio (RR), 2.11; P(trend) = 0.001], acute monocytic leukemia (RR, 2.51; P(trend) = 0.002), and multiple myeloma (RR, 1.34; P(trend) = 0.006). Having three or more older siblings compared with none decreased the risk of acute monocytic leukemia (RR, 0.35; P(trend) = 0.001) and childhood ALL (RR, 0.69; P(trend) = 0.01). The risk of Hodgkin's lymphoma for five or more older siblings compared with none was 0.41 (P(trend) = 0.003). Acute myeloid leukemia, chronic lymphocytic leukemia, and other lymphoproliferative malignancies were not associated with number of siblings. In conclusion, we found an excess risk of childhood ALL and acute monocytic leukemia in large families. However, for ALL, acute monocytic leukemia, and Hodgkin's lymphoma, younger siblings were strongly protected compared with older siblings. The remarkable protective effect of number of older siblings on acute monocytic leukemia is a novel finding of potential interest. Possible interpretations of our findings in the context of a putative infectious etiology are discussed.
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Affiliation(s)
- Andrea Altieri
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg
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10
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Burjanivova T, Madzo J, Muzikova K, Meyer C, Schneider B, Votava F, Marschalek R, Stary J, Trka J, Zuna J. Prenatal origin of childhood AML occurs less frequently than in childhood ALL. BMC Cancer 2006; 6:100. [PMID: 16630339 PMCID: PMC1463004 DOI: 10.1186/1471-2407-6-100] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 04/21/2006] [Indexed: 11/17/2022] Open
Abstract
Background While there is enough convincing evidence in childhood acute lymphoblastic leukemia (ALL), the data on the pre-natal origin in childhood acute myeloid leukemia (AML) are less comprehensive. Our study aimed to screen Guthrie cards (neonatal blood spots) of non-infant childhood AML and ALL patients for the presence of their respective leukemic markers. Methods We analysed Guthrie cards of 12 ALL patients aged 2–6 years using immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements (n = 15) and/or intronic breakpoints of TEL/AML1 fusion gene (n = 3). In AML patients (n = 13, age 1–14 years) PML/RARalpha (n = 4), CBFbeta/MYH11 (n = 3), AML1/ETO (n = 2), MLL/AF6 (n = 1), MLL/AF9 (n = 1) and MLL/AF10 (n = 1) fusion genes and/or internal tandem duplication of FLT3 gene (FLT3/ITD) (n = 2) were used as clonotypic markers. Assay sensitivity determined using serial dilutions of patient DNA into the DNA of a healthy donor allowed us to detect the pre-leukemic clone in Guthrie card providing 1–3 positive cells were present in the neonatal blood spot. Results In 3 patients with ALL (25%) we reproducibly detected their leukemic markers (Ig/TCR n = 2; TEL/AML1 n = 1) in the Guthrie card. We did not find patient-specific molecular markers in any patient with AML. Conclusion In the largest cohort examined so far we used identical approach for the backtracking of non-infant childhood ALL and AML. Our data suggest that either the prenatal origin of AML is less frequent or the load of pre-leukemic cells is significantly lower at birth in AML compared to ALL cases.
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MESH Headings
- Biomarkers, Tumor/blood
- Bone Marrow Cells/chemistry
- Child
- Child, Preschool
- Clone Cells/chemistry
- Cohort Studies
- Core Binding Factor Alpha 2 Subunit/blood
- Core Binding Factor Alpha 2 Subunit/genetics
- DNA, Neoplasm/blood
- Female
- Fetal Blood/chemistry
- Gene Duplication
- Gene Rearrangement, B-Lymphocyte
- Gene Rearrangement, T-Lymphocyte
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/embryology
- Leukemia, Myeloid/epidemiology
- Leukemia, Myeloid/genetics
- Male
- Myeloid-Lymphoid Leukemia Protein/blood
- Myeloid-Lymphoid Leukemia Protein/genetics
- Neonatal Screening
- Neoplasm Proteins/blood
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/blood
- Oncogene Proteins, Fusion/genetics
- Polymerase Chain Reaction
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/embryology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- RUNX1 Translocation Partner 1 Protein
- Tandem Repeat Sequences
- fms-Like Tyrosine Kinase 3/blood
- fms-Like Tyrosine Kinase 3/genetics
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Affiliation(s)
- Tatiana Burjanivova
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Jozef Madzo
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Katerina Muzikova
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Claus Meyer
- Institute of Pharmaceutical Biology/DCAL, University of Frankfurt, Frankfurt/Main, Germany
| | - Bjoern Schneider
- Institute of Pharmaceutical Biology/DCAL, University of Frankfurt, Frankfurt/Main, Germany
| | - Felix Votava
- Department of Pediatrics, Charles University Prague, 3rd Medical School, Czech Republic
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology/DCAL, University of Frankfurt, Frankfurt/Main, Germany
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Jan Trka
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
| | - Jan Zuna
- CLIP – Childhood Leukaemia Investigation Prague, Czech Republic
- Department of Pediatric Hematology and Oncology, Charles University Prague, 2nd Medical School, Czech Republic
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Broadfield ZJ, Hain RDW, Harrison CJ, Reza Jalali G, McKinley M, Michalová K, Robinson HM, Zemanová Z, Martineau M. Complex chromosomal abnormalities in utero
, 5 years before leukaemia*. Br J Haematol 2004; 126:307-12. [PMID: 15257702 DOI: 10.1111/j.1365-2141.2004.05036.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Prenatal acquisition of leukaemia-associated gene rearrangements is a well-established phenomenon. This is the first report of a complex cytogenetic clone, in association with an ETV6/AML1 fusion, developing in utero. Identical twin girls, aged 4 years, developed ETV6/AML1-positive acute lymphoblastic leukaemia (ALL) within 3 months of one another. Both demonstrated an identical four way, variant t(12;21). There was gain of an AML1 signal in twin 1 and loss of an ETV6 one in twin 2 at interphase. This unique case study demonstrates that ETV6/AML1 fusion and the associated complex chromosomal rearrangements occurred in utero. Clonal expansion of the abnormal cell in one twin was followed by metastasis to the other. There was a prolonged preleukaemic phase, which lasted well into childhood. The short time between the two diagnoses of ALL suggests a common precipitating event. The significance of the different secondary markers remains unclear.
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Affiliation(s)
- Zoë J Broadfield
- Leukaemia Research Fund Cytogenetics Group, Cancer Sciences Division, University of Southampton, Southampton, UK.
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