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Osumi T, Watanabe A, Okamura K, Nakabayashi K, Yoshida M, Tsujimoto SI, Uchiyama M, Takahashi H, Tomizawa D, Hata K, Kiyokawa N, Kato M. Acute promyelocytic leukemia with a cryptic insertion of RARA into TBL1XR1. Genes Chromosomes Cancer 2019; 58:820-823. [PMID: 31350930 DOI: 10.1002/gcc.22791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 01/22/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is cytogenetically characterized by the t(15;17) (q24;q21), although cases without this translocation exist. These cases are referred to as "cryptic" or "masked" translocations. Additionally, fewer than 5% of APL cases have another partner gene fused to the RARA gene. The TBL1XR1-RARA fusion gene has recently been reported as a novel RARA-associated fusion gene. We report a case with TBL1XR1-RARA and a masked translocation that was not detected by conventional tests for RARA-associated translocations. Three-year-old girl was diagnosed with APL based morphological findings, although conventional tests for RARA-associated chimeric genes were negative. She received all-trans retinoic acid treatment, but that was not effective. She achieved a complete remission (CR) by conventional multidrug chemotherapy, but had extramedullary relapse 2 years after onset. She underwent cord blood transplantation (CBT) in her second CR and is currently alive. To investigate the underlying pathogenesis of this unique case, we performed whole-genome sequencing and found a cryptic insertion of RARA gene into the TBL1XR1 gene. The transcript of the chimeric gene, TBL1XR1-RARA, was confirmed as an in-frame fusion by RT-PCR. In conclusion, we found using next-generation sequencing (NGS) a TBL1XR1-RARA fusion in a child with variant APL without the classic karyotype. Cryptic insertion could also occur in cases other than APL with PML-RARA. Variant APL has many variants and NGS analysis should therefore be considered for APL variant cases, even for those without RARA translocation detected by conventional analysis.
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Affiliation(s)
- Tomoo Osumi
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiro Watanabe
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kohji Okamura
- Department of Systems BioMedicine, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Masanori Yoshida
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Yokohama City University, Yokohama, Japan
| | - Shin-Ichi Tsujimoto
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Yokohama City University, Yokohama, Japan
| | - Meri Uchiyama
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Nobutaka Kiyokawa
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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Cao Y, Yao L, Liu Y, Gu Q, Dong W, Wang Z, Wang F, Lin R, Xie X, Cen J, Chen S, Gu W. An Atypical PML-RARA Rearrangement Resulting from Submicroscopic Insertion of the RARA Gene at the PML Locus with Novel Breakpoints within PML Exon 7b and RARA Exon 3. Acta Haematol 2019; 142:98-104. [PMID: 31085908 DOI: 10.1159/000498842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/09/2019] [Indexed: 12/21/2022]
Abstract
The diagnostic hallmark of acute promyelocytic leukemia (APL) is the reciprocal translocation t(15;17), resulting in the characteristic PML-RARA fusion; however, patients occasionally have masked PML-RARArearrangements. We report an APL case with no evidence of t(15;17) or PML-RARA rearrangement by karyotype or commercial reverse transcription polymerase chain reaction analyses. Fluorescence in situ hybridization detected a small RARA insertion signal within PML. mRNA sequencing identified a novel PML-RARA transcript generated from the juxtaposition of PMLIIa (exons 1-4, 6, and 7ab) and RARA exons (3-9), with novel breakpoints in PML exon 7b and RARA exon 3. The patient achieved molecular remission after the second consolidation chemotherapy and remains in complete remission 22 months after initial presentation. This is the first report of an APL case presenting with submicroscopic ins(15;17) and simultaneous novel breakpoints in both PML and RARA. This case highlights the importance of sequence analysis to confirm APL diagnosis and for subsequent monitoring of minimal residual disease.
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MESH Headings
- Adult
- Exons
- Genetic Loci
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Mutagenesis, Insertional
- Oncogene Proteins, Fusion/genetics
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Affiliation(s)
- Yang Cao
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Li Yao
- Laboratory of Leukemia, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Liu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Quan Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Weimin Dong
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhilin Wang
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fei Wang
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Rongrong Lin
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaobao Xie
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jiannong Cen
- Laboratory of Leukemia, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Suning Chen
- Laboratory of Leukemia, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiying Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China,
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Koutsi A, Vervesou EC. Diagnostic molecular techniques in haematology: recent advances. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:242. [PMID: 30069444 DOI: 10.21037/atm.2018.05.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hematopoietic disorders are often driven by genetic mutations and epigenetic alterations. New advanced technologies including next-generation sequencing, ultra-deep PCR and whole-genome and exome sequencing were proved very efficient in detecting several mutations implicated in the pathogenesis of hematological diseases. Emerging evidence indicates that genomic data can be useful in all aspects of clinical practice including diagnosis, prognosis and prediction of response to specific treatments, as well as in the development of novel targeted treatments for patients with hematological disorders.
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Affiliation(s)
- Aikaterini Koutsi
- Department of Hematology, Errikos Dunant Hospital Center, Athens, Greece
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Venci A, Mazza R, Spinelli O, Di Schiena L, Bettio D. Acute promyelocytic leukemia with a cryptic insertion of RARA into PML on chromosome 15 due to uniparental isodisomy: A case report. Oncol Lett 2017; 13:4180-4184. [PMID: 28599418 PMCID: PMC5453168 DOI: 10.3892/ol.2017.5979] [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: 08/17/2016] [Accepted: 11/30/2016] [Indexed: 01/03/2023] Open
Abstract
Acute promyelocytic leukemia is a myeloid disorder that is characterized by the specific t(15;17) variant in ~98% of cases. The typical hypergranular and microgranular or hypogranular types exist, and are frequently associated with disseminated intravascular coagulopathy. Rare cases of promyelocytic leukemia-retinoic acid receptor α (PML-RARA) fusion without the reciprocal RARA-PML have been reported in cytogenetically normal samples. Conversely, fluorescence in situ hybridization (FISH) analysis has revealed a cryptic insertion of the RARA gene into the PML gene on chromosome 15. The current study reports a unique case with a normal karyotype and molecular evidence of the PML-RARA short isoform 3-fusion transcript, with FISH analysis revealing two fusion signals on the two copies of chromosome 15, but absence of the reciprocal on the two copies of chromosome 17. This finding raised the hypothesis of chromosome 15 uniparental isodysomy as consequence of normal chromosome 15 loss and duplication of the rearranged chromosome, as supported by polymorphic loci molecular analysis. The clinical, cytogenetic and molecular characterization of this case are presented and discussed in the present study.
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Affiliation(s)
- Anna Venci
- Cytogenetic and Medical Genetic Laboratory, Operative Unit of Clinical Investigations, Humanitas Clinical and Research Center, I-20089 Milan, Italy
| | - Rita Mazza
- Operative Unit of Medical Oncology and Hematology, Humanitas Clinical and Research Center, I-20089 Milan, Italy
| | - Orietta Spinelli
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, I-24127 Bergamo, Italy
| | - Luciana Di Schiena
- Cytogenetic and Medical Genetic Laboratory, Operative Unit of Clinical Investigations, Humanitas Clinical and Research Center, I-20089 Milan, Italy
| | - Daniela Bettio
- Cytogenetic and Medical Genetic Laboratory, Operative Unit of Clinical Investigations, Humanitas Clinical and Research Center, I-20089 Milan, Italy
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