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Zanelli M, Fragliasso V, Loscocco GG, Sanguedolce F, Broggi G, Zizzo M, Palicelli A, Ricci S, Ambrogi E, Martino G, Aversa S, Coppa F, Gentile P, Gozzi F, Caltabiano R, Koufopoulos N, Asaturova A, Cimino L, Cavazza A, Orcioni GF, Ascani S. Chronic myeloproliferative neoplasms with concomitant CALR mutation and BCR::ABL1 translocation: diagnostic and therapeutic implications of a rare hybrid disease. Front Cell Dev Biol 2024; 12:1391078. [PMID: 38596359 PMCID: PMC11002177 DOI: 10.3389/fcell.2024.1391078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Myeloproliferative neoplasms (MPNs) are subdivided into Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) and Ph-negative MPNs. BCR::ABL1 translocation is essential for the development and diagnosis of CML; on the other hand, the majority of Ph-negative MPNs are characterized by generally mutually exclusive mutations of Janus kinase 2 (JAK2), calreticulin (CALR), or thrombopoietin receptor/myeloproliferative leukemia (MPL). CALR mutations have been described essentially in JAK2 and MPL wild-type essential thrombocythemia and primary myelofibrosis. Rarely coexisting CALR and MPL mutations have been found in Ph-negative MPNs. BCR::ABL1 translocation and JAK2 mutations were initially considered mutually exclusive genomic events, but a discrete number of cases with the combination of these genetic alterations have been reported. The presence of BCR::ABL1 translocation with a coexisting CALR mutation is even more uncommon. Herein, starting from a routinely diagnosed case of CALR-mutated primary myelofibrosis subsequently acquiring BCR::ABL1 translocation, we performed a comprehensive review of the literature, discussing the clinicopathologic and molecular features, as well as the outcome and treatment of cases with BCR::ABL1 and CALR co-occurrence.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emila, Italy
| | - Giuseppe Gaetano Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Doctorate School GenOMec, University of Siena, Siena, Italy
| | | | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ricci
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Ambrogi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
- Hematology, Centro di Ricerca Emato-Oncologica-C.R.E.O., University of Perugia, Perugia, Italy
| | - Sara Aversa
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Francesca Coppa
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Pietro Gentile
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Aleksandra Asaturova
- Pathology Department, FSBI “National Medical Research Centre for Ostetrics, Gynecology and Perinatology Named After Academician V.I Kulakov” of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
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Limsuwanachot N, Rerkamnuaychoke B, Niparuck P, Singdong R, Kongruang A, Hirunpatrawong P, Siriyakorn T, Yenchitsomanus PT, Siriboonpiputtana T. A customized mass array panel for BCR:: ABL1 tyrosine kinase domain mutation screening in chronic myeloid leukemia. J Mass Spectrom Adv Clin Lab 2023; 28:122-132. [PMID: 37128502 PMCID: PMC10148036 DOI: 10.1016/j.jmsacl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/25/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
Introduction The therapeutic strategy and management of chronic myeloid leukemia (CML) have rapidly improved with the discovery of effective tyrosine kinase inhibitors (TKIs) to target BCR::ABL1 oncoprotein. However, nearly 30% of patients develop TKI resistance due to acquired mutations on the tyrosine kinase domain (TKD) of BCR::ABL1. Methods We customized a mass array panel initially intended to detect and monitor the mutational burden of hotspot BCR::ABL1 TKD mutations accumulated in our database, including key mutations recently recommended by European LeukemiaNet. Additionally, we extended the feasibility of using the assay panel for the molecular classification of myeloproliferative neoplasms (MPNs) by incorporating primer sets specific for analyzing JAK2 V617F, MPL 515 K/L, and CALR types 1 and 2. Results We found that the developed mass array panel was superior for detecting and monitoring clinically significant BCR::ABL1 TKD mutations, especially in cases with low mutational burden and harboring compound/polyclonal mutations, compared with direct sequencing. Moreover, our customized mass array panel detected common genetic alterations in MPNs, and the findings were consistent with those of other comparable assays available in our laboratory. Conclusions Our customized mass array panel was practicably used as a routine robust assay for screening and monitoring BCR::ABL1 TKD mutations in patients with CML undergoing TKI treatment and feasible for analyzing common genetic mutations in MPNs.
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Affiliation(s)
- Nittaya Limsuwanachot
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Budsaba Rerkamnuaychoke
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Roongrudee Singdong
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adcharee Kongruang
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Pa-thai Yenchitsomanus
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Siriboonpiputtana
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Corresponding author at: Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
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Combaluzier S, Quessada J, Abbou N, Arcani R, Tichadou A, Gabert J, Costello R, Loosveld M, Venton G, Berda-Haddad Y. Cytological Diagnosis of Classic Myeloproliferative Neoplasms at the Age of Molecular Biology. Cells 2023; 12:cells12060946. [PMID: 36980287 PMCID: PMC10047531 DOI: 10.3390/cells12060946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Myeloproliferative neoplasms (MPN) are clonal hematopoietic stem cell-derived disorders characterized by uncontrolled proliferation of differentiated myeloid cells. Two main groups of MPN, BCR::ABL1-positive (Chronic Myeloid Leukemia) and BCR::ABL1-negative (Polycythemia Vera, Essential Thrombocytosis, Primary Myelofibrosis) are distinguished. For many years, cytomorphologic and histologic features were the only proof of MPN and attempted to distinguish the different entities of the subgroup BCR::ABL1-negative MPN. World Health Organization (WHO) classification of myeloid neoplasms evolves over the years and increasingly considers molecular abnormalities to prove the clonal hematopoiesis. In addition to morphological clues, the detection of JAK2, MPL and CALR mutations are considered driver events belonging to the major diagnostic criteria of BCR::ABL1-negative MPN. This highlights the preponderant place of molecular features in the MPN diagnosis. Moreover, the advent of next-generation sequencing (NGS) allowed the identification of additional somatic mutations involved in clonal hematopoiesis and playing a role in the prognosis of MPN. Nowadays, careful cytomorphology and molecular biology are inseparable and complementary to provide a specific diagnosis and to permit the best follow-up of these diseases.
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Affiliation(s)
- Sophie Combaluzier
- Hematology Laboratory, Timone University Hospital, 13005 Marseille, France
| | - Julie Quessada
- Hematological Cytogenetics Laboratory, Timone University Hospital, 13005 Marseille, France
- CNRS, INSERM, CIML, Luminy Campus, Aix-Marseille University, 13009 Marseille, France
| | - Norman Abbou
- Molecular Biology Laboratory, North University Hospital, 13015 Marseille, France
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
| | - Robin Arcani
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
- Department of Internal Medicine, Timone University Hospital, 13005 Marseille, France
| | - Antoine Tichadou
- Hematology and Cellular Therapy Department, Conception University Hospital, 13005 Marseille, France
| | - Jean Gabert
- Molecular Biology Laboratory, North University Hospital, 13015 Marseille, France
| | - Régis Costello
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
- Hematology and Cellular Therapy Department, Conception University Hospital, 13005 Marseille, France
- TAGC, INSERM, UMR1090, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
| | - Marie Loosveld
- Hematology Laboratory, Timone University Hospital, 13005 Marseille, France
- Hematological Cytogenetics Laboratory, Timone University Hospital, 13005 Marseille, France
- CNRS, INSERM, CIML, Luminy Campus, Aix-Marseille University, 13009 Marseille, France
| | - Geoffroy Venton
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
- Hematology and Cellular Therapy Department, Conception University Hospital, 13005 Marseille, France
- TAGC, INSERM, UMR1090, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
| | - Yaël Berda-Haddad
- Hematology Laboratory, Timone University Hospital, 13005 Marseille, France
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Huo L, Xie J, Wang Q, Shen H, Ding Z, Wen L, Zeng Z, Xu Y, Ruan C, Chen S, Xue M. Insights from a rare myeloproliferative neoplasm with coexisting BCR-ABL1 fusion gene, CALR, and TET2 mutations treated with nilotinib and ruxolitinib. Clin Case Rep 2023; 11:e6801. [PMID: 36703773 PMCID: PMC9871410 DOI: 10.1002/ccr3.6801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/04/2022] [Accepted: 12/13/2022] [Indexed: 01/26/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) with concurrent BCR-ABL1 fusion gene and CALR mutation are especially rare. We report a patient with coexisting BCR-ABL1 fusion gene, CALR, and TET2 mutations who was treated with the combination of the second-generation TKI nilotinib and JAK1/JAK2 inhibitor ruxolitinib.
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Affiliation(s)
- Li Huo
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jundan Xie
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Qian Wang
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Hongjie Shen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zixuan Ding
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Lijun Wen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhao Zeng
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yi Xu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Changgeng Ruan
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Collaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Suning Chen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Collaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Mengxing Xue
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Geng H, Zheng Z, Wang S. BCR::ABL1-positive chronic myeloid leukaemia with CALR mutation. Clin Exp Pharmacol Physiol 2023; 50:425-427. [PMID: 36636958 DOI: 10.1111/1440-1681.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Haili Geng
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fujian Medical Center of Hematology, Fuzhou, Fujian, China
| | - Zhengjin Zheng
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fujian Medical Center of Hematology, Fuzhou, Fujian, China
| | - Shaoyuan Wang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fujian Medical Center of Hematology, Fuzhou, Fujian, China
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Zhang X, Wang F, Yu J, Jiang Z. Significance of bone marrow fibrosis in acute myeloid leukemia for survival in the real-world. Front Oncol 2022; 12:971082. [PMID: 36276150 PMCID: PMC9585239 DOI: 10.3389/fonc.2022.971082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
Abstract
Acute myeloid leukemia (AML) is a highly heterogeneous hematologic malignancy characterized by the proliferation of myeloid blasts. Bone marrow fibrosis (BMF), characterized by increased deposition of reticulin or collagen fibers, can occur in AML. International authoritative guidelines do not mention AML patients with BMF and the reported studies are inconsistent. Therefore, we retrospectively analyzed the clinical data of newly diagnosed AML patients in our hospital and compared the clinical characteristics, gene mutations and prognosis of AML patients with or without BMF. We found AML patients with BMF tended to be older, were more prone to hepatosplenomegaly, their level of β2-MG was higher and they often had karyotypes associated with a poor prognosis. The proportion of AML patients without BMF was high in the intermediate-risk group and low in the high-risk group. The mutation rates of ASXL1 and TET2 genes were higher and that of CEBPA was lower in the BMF group. Multivariate analysis showed BMF had independent prognostic significance. AML patients without BMF had higher CR/CRi rate, and the time of hematopoietic recovery in patients achieving CR/CRi was longer in BMF group. The degree of BMF, prognostic level and blasts in peripheral blood were independent risk factors for CR/CRi in newly diagnosed AML. AML patients in the BMF group, especially those with BMF ≥ 2, had a lower OS rate. In age<60 years old group, the higher the degree of BMF was, the shorter the median survival time and the lower the OS rate. In age ≥ 60 years old group, the median survival time in the BMF-1 and the BMF-2/3 groups was shorter. For AML with low, intermediate and high risk, there was always a lower OS rate in patients with BMF. The median survival of AML patients decreased with an increasing degree of BMF in different risk stratifications. BMF had no effect on OS of AML patients with HSCT. In conclusion, AML patients with BMF have a poor prognosis, and BMF was an independent prognostic factor for OS. The assessment of BMF was of great significance for the treatment efficacy and prognosis of newly diagnosed AML.
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Affiliation(s)
- Xia Zhang
- *Correspondence: Xia Zhang, ; Zhongxing Jiang,
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Nann D, Fend F. Synoptic Diagnostics of Myeloproliferative Neoplasms: Morphology and Molecular Genetics. Cancers (Basel) 2021; 13:cancers13143528. [PMID: 34298741 PMCID: PMC8303289 DOI: 10.3390/cancers13143528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary The diagnosis of myeloproliferative neoplasms requires assessment of a combination of clinical, morphological, immunophenotypic and genetic features, and this integrated, multimodal approach forms the basis for precise classification. Evaluation includes cell counts and morphology in the peripheral blood, bone marrow aspiration and trephine biopsy, and may encompass flow cytometry for specific questions. Diagnosis nowadays is completed by targeted molecular analysis for the detection of recurrent driver and, optionally, disease-modifying mutations. According to the current World Health Organization classification, all myeloproliferative disorders require assessment of molecular features to support the diagnosis or confirm a molecularly defined entity. This requires a structured molecular analysis workflow tailored for a rapid and cost-effective diagnosis. The review focuses on the morphological and molecular features of Ph-negative myeloproliferative neoplasms and their differential diagnoses, addresses open questions of classification, and emphasizes the enduring role of histopathological assessment in the molecular era. Abstract The diagnosis of a myeloid neoplasm relies on a combination of clinical, morphological, immunophenotypic and genetic features, and an integrated, multimodality approach is needed for precise classification. The basic diagnostics of myeloid neoplasms still rely on cell counts and morphology of peripheral blood and bone marrow aspirate, flow cytometry, cytogenetics and bone marrow trephine biopsy, but particularly in the setting of Ph− myeloproliferative neoplasms (MPN), the trephine biopsy has a crucial role. Nowadays, molecular studies are of great importance in confirming or refining a diagnosis and providing prognostic information. All myeloid neoplasms of chronic evolution included in this review, nowadays feature the presence or absence of specific genetic markers in their diagnostic criteria according to the current WHO classification, underlining the importance of molecular studies. Crucial differential diagnoses of Ph− MPN are the category of myeloid/lymphoid neoplasms with eosinophilia and gene rearrangement of PDGFRA, PDGFRB or FGFR1, or with PCM1-JAK2, and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). This review focuses on morphological, immunophenotypical and molecular features of BCR-ABL1-negative MPN and their differential diagnoses. Furthermore, areas of difficulties and open questions in their classification are addressed, and the persistent role of morphology in the area of molecular medicine is discussed.
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Affiliation(s)
- Dominik Nann
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Comprehensive Cancer Center, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Comprehensive Cancer Center, University Hospital Tübingen, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-2980207
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Xiao M, Qin L, Niu X, Zhou P, Niu J, Wei S, Li D, Dou L, Zhang W, Zhang L, Sun K, Bai Y. Acute promyelocytic leukemia with myelofibrosis: A case report and literature review. Medicine (Baltimore) 2021; 100:e24567. [PMID: 33787572 PMCID: PMC8021289 DOI: 10.1097/md.0000000000024567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Acute promyelocytic leukemia (APL) with myelofibrosis (MF) is rare, and only 14 cases have been reported in the literature to date. PATIENT CONCERNS A 42-year-old woman was admitted to the hospital with easy bruising and excessive bleeding. With the remission of the primary disease during treatment, the degree of fibrosis did not decrease, but worsened progressively. DIAGNOSIS The woman was diagnosed with acute promyelocytic leukemia with secondary myelofibrosis. INTERVENTIONS All-trans retinoic acid (ATRA) was discontinued after 6 months of complete remission of APL. Arsenic trioxide (ATO) was discontinued because of supraventricular tachycardia 9 months after complete remission of APL. OUTCOMES After withdrawal of ATRA for 2 months, the degree of fibrosis was significantly alleviated, and after withdrawal of ATRA for 8 months and ATO for 5 months, bone marrow biopsy showed no reticular fiber deposition. LESSONS In this case report and review of an additional 14 cases of APL with MF, we highlighted the importance of the degree of MF to be evaluated by bone marrow biopsy at the time of bone marrow aspiration when APL is suspected. If MF is present, the type of MF should be determined in a timely manner, and appropriate intervention measures should be taken accordingly.
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Affiliation(s)
- Mengyu Xiao
- Department of Hematology, Zhengzhou University People's Hospital
| | - Ling Qin
- Department of Hematology, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang
| | - Xiaona Niu
- Department of Hematology, Zhengzhou University People's Hospital
| | - Pan Zhou
- Department of Hematology, Zhengzhou University People's Hospital
| | - Junwei Niu
- Department of Hematology, Zhengzhou University People's Hospital
| | - Shengjie Wei
- Department of Hematology, Zhengzhou University People's Hospital
| | - Dan Li
- Department of Hematology, Zhengzhou University People's Hospital
| | - Liurui Dou
- Department of Hematology, Zhengzhou University People's Hospital
| | - Wanjun Zhang
- Department of Hematology, Zhengzhou University People's Hospital
| | - Lei Zhang
- Department of Hematology, Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou, Henan, PR China
| | - Kai Sun
- Department of Hematology, Zhengzhou University People's Hospital
| | - Yanliang Bai
- Department of Hematology, Zhengzhou University People's Hospital
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Zhang Y, Tan Q, Cao P, Chen C, Chen W. Chronic myeloid leukemia with a significant increase of monocytes and rare karyotype: A case report and literature review. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:322-327. [PMID: 33927081 PMCID: PMC10929936 DOI: 10.11817/j.issn.1672-7347.2021.200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 11/03/2022]
Abstract
Chronic myeloid leukemia with a significant increase of monocytes is rare and difficult to identify from chronic myelo-monocytic leukemia in clinic. A 31-year-old male patient with systemic pain was initially diagnosed as chronic myelo-monocytic leukemia, who was finally diagnosed as chronic myeloid leukemia by fusion gene and chromosome examination. In addition to the typical Ph chromosome, a rare chromosome translocation t(2; 7)(p13; p22) was observed. The detection of monocyte subsets by multi-parameter flow cytometry is a diagnostic marker to distinguish the above 2 diseases. The relationship between fusion genes and mononucleosis is not clear. Tyrosine kinase inhibitors or allogeneic hematopoietic stem cell transplantation can be used in the treatment for this disease.
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Affiliation(s)
- Ying Zhang
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008.
| | - Qian Tan
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008
| | - Pengfei Cao
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008
| | - Cong Chen
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008
| | - Wei Chen
- Department of Gastroenterology, Changsha Central Hospital, Changsha 410004, China.
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