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Borges MLRDR, Souza JLC, Rodrigues LH, Cornélio MTMN, Anjos ACD, Santos N, Salles TDJM. Clinical and cytogenetic profile of Fanconi anemia diagnosed after implementation of mitomycin C cytogenetic test in the state of Pernambuco, Brazil. Hematol Transfus Cell Ther 2024; 46:113-118. [PMID: 36759292 DOI: 10.1016/j.htct.2022.11.011] [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: 01/25/2022] [Revised: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Fanconi anemia (FA) is a rare autosomal recessive disease characterized by chromosomal instability and increased predisposition to malignancy. The diagnosis of FA requires clinical evaluation, confirmation of chromosomal fragility and/or analysis of genetic mutations. Therefore, this study aims to identify the clinical profile of patients with FA in the state of Pernambuco, Brazil. METHOD We analyzed 100 individuals referred from the major hematology and bone marrow (BM) transplant centers in the state of Pernambuco, Brazil, between the years 2018 and 2022. The diagnosis of FA was performed using the mitomycin C chromosomal fragility test, clinical data and classical and molecular cytogenetic analyses. RESULTS We enrolled a total of 16 patients with FA to comprise this study. Most of these individuals (87.5%) came from the Agreste and Sertão regions of Pernambuco. We observed a slight female prevalence of FA (1.3:1). The primary clinical and laboratory findings were café au lait spots (62.5%) and bone abnormalities (53%, mainly thumb deformities [40%]). We performed BM cytogenetic analysis for eight patients - seven showed no chromosomal abnormalities and one presented the karyotype 47,XY,+21 [15]. CONCLUSIONS Our results are important to promote public health measures for the early diagnosis of FA, as well as to foster the engagement of a multidisciplinary group in the treatment of this disease.
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Affiliation(s)
| | | | | | | | | | - Neide Santos
- Universidade Federal de Pernambuco (UFP), Recife, PE, Brazil
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Lovatel VL, de Souza DC, Alvarenga TF, Capela de Matos RR, Diniz C, Schramm MT, Llerena Júnior JC, Silva MLM, Abdelhay E, de Souza Fernandez T. An uncommon t(9;11)(p24;q22) with monoallelic loss of ATM and KMT2A genes in a child with myelodysplastic syndrome/acute myeloid leukemia who evolved from Fanconi anemia. Mol Cytogenet 2018; 11:40. [PMID: 30008805 PMCID: PMC6042331 DOI: 10.1186/s13039-018-0389-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/28/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Myelodysplastic syndrome (MDS) is rare in the pediatric age group and it may be associated with inheritable bone marrow failure (BMF) such as Fanconi anemia (FA). FA is a rare multi-system genetic disorder, characterized by congenital malformations and progressive BMF. Patients with FA usually present chromosomal aberrations when evolving to MDS or acute myeloid leukemia (AML). Thus, the cytogenetic studies in the bone marrow (BM) of these patients have an important role in the therapeutic decision, mainly in the indication for hematopoietic stem cell transplantation (HSCT). The most frequent chromosomal alterations in the BM of FA patients are gains of the chromosomal regions 1q and 3q, and partial or complete loss of chromosome 7. However, the significance and the predictive value of such clonal alterations, with respect to malignant progress, are not fully understood and data from molecular cytogenetic studies are very limited. CASE PRESENTATION A five-year-old boy presented recurrent infections and persistent anemia. The BM biopsy revealed hypocellularity. G-banding was performed on BM cells and showed a normal karyotype. The physical examination showed to be characteristic of FA, being the diagnosis confirmed by DEB test. Five years later, even with supportive treatment, the patient presented severe hypocellularity and BM evolution revealing megakaryocyte dysplasia, intense dyserythropoiesis, and 11% myeloblasts. G-banded analysis showed an abnormal karyotype involving a der(9)t(9;11)(p24;q?22). The FISH analysis showed the monoallelic loss of ATM and KMT2A genes. At this moment the diagnosis was MDS, refractory anemia with excess of blasts (RAEB). Allogeneic HSCT was indicated early in the diagnosis, but no donor was found. Decitabine treatment was initiated and well tolerated, although progression to AML occurred 3 months later. Chemotherapy induction was initiated, but there was no response. The patient died due to disease progression and infection complications. CONCLUSIONS Molecular cytogenetic analysis showed a yet unreported der(9)t(9;11)(p24;q?22),der(11)t(9;11)(p24;q?22) during the evolution from FA to MDS/AML. The FISH technique was important allowing the identification at the molecular level of the monoallelic deletion involving the KMT2A and ATM genes. Our results suggest that this chromosomal alteration conferred a poor prognosis, being associated with a rapid leukemic transformation and a poor treatment response.
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Affiliation(s)
- Viviane Lamim Lovatel
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Post-Graduate Program in Oncology, National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Daiane Corrêa de Souza
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Tatiana Fonseca Alvarenga
- Pathology Department of National Cancer Institute (INCA) and Post-Graduation Program in Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Roberto R. Capela de Matos
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Post-Graduate Program in Oncology, National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Claudia Diniz
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | | | - Juan Clinton Llerena Júnior
- Medical Genetic Departament, Fernandes Figueira National Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | - Maria Luiza Macedo Silva
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Post-Graduate Program in Oncology, National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Eliana Abdelhay
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Post-Graduate Program in Oncology, National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Teresa de Souza Fernandez
- Bone Marrow Transplatation Center (CEMO), National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Post-Graduate Program in Oncology, National Cancer Institute José de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
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