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Razmara Lak E, Sharifzadeh S, Ramzi M, Mokhtari M, Asadpouri R, Abedi E, Tamaddon G. Philadelphia Chromosome Positive Chronic Myelogenous Leukemia Blastic Crisis in a Patient with Unusual Primary Myelofibrosis Characteristics; A Case Report. Cardiovasc Hematol Agents Med Chem 2024; 22:240-245. [PMID: 37317905 DOI: 10.2174/1871525721666230614110621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/22/2023] [Accepted: 03/29/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Myeloproliferative neoplasms (MPNs) are divided into BCR-ABL positive Chronic myeloid leukemia (CML) and BCR-ABL negative MPNs including Polycythemia vera (PV), Essential Thrombocythemia (ET) and Primary myelofibrosis (PMF). Evaluation of the Philadelphia chromosome in MPNs is a diagnostic requirement for classic CML. CASE REPORT In 2020, a 37-year-old woman with negative cytogenetic testing for Janus kinase2 (JAK2), Calreticulin (CALR), myeloproliferative leukemia virus oncogene (MPL), and positive for BCR-ABL1 mutation with reticular fibrosis in bone marrow was diagnosed as CML. Some years ago, the patient had been diagnosed with PMF with evidence of histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease (KFD). The BCR-ABL fusion gene was initially evaluated which was negative. Then, Cutaneous squamous cell carcinoma (cSCC) was confirmed by Dermatopathologist with palpable splenomegaly and high white blood cell (WBC) count with basophilia. Finally, BCR-ABL was detected positive by the fluorescence in situ hybridization (FISH) and quantitative real-time polymerase chain reaction (qRT-PCR). In fact, the co-occurrence of PMF with CML was identified. CONCLUSION This case study highlighted the importance of some cytogenetic methods in the detection and classification of MPNs. It is recommended that physicians pay more attention to it and be aware of the planning treatment.
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Affiliation(s)
- Elahe Razmara Lak
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Sharifzadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Department of Pathology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Asadpouri
- Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Elham Abedi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Tamaddon
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhang Y, Bi H, Wang Y, Chen L, Pan J, Xu P, Wang W, Yang S. BCR-ABL1 is a secondary event after JAK2V617F in a patient with essential thrombocythemia who develop chronic myeloid leukemia. BLOOD SCIENCE 2022; 4:199-204. [PMID: 36518237 PMCID: PMC9742103 DOI: 10.1097/bs9.0000000000000129] [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: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 06/17/2023] Open
Abstract
Several cases such as myeloproliferative neoplasms (MPN) with the coexistence of JAK2 and BCR-ABL have been reported. However, cases of transformation of essential thrombocythemia (ET) into chronic myeloid leukemia (CML) during the disease progression were rarely reported. Here, we report the case of a patient with JAK2 V617F- positive ET who subsequently acquired BCR-ABL1, which transformed the disease into CML after 10 years from the initial diagnosis. In this study, we dynamically monitored JAK2 V617F and BCR-ABL and observed multiple gene mutations, including IDH2, IDH1, ASXL1, KRAS, and RUNX1. It is important to be aware of this potentially clone evolution in disease progression.
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Affiliation(s)
- Yanqing Zhang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Hailiang Bi
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Ying Wang
- The Seventh Affiliated Hospital, Sun Yat-sen of University, Shenzhen, Guangdong, P. R. China
| | - Long Chen
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Jiaqi Pan
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Ping Xu
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Wei Wang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Shaobin Yang
- Department of Molecular Biology Laboratory, Tianjin SINO-US-Diagnostics Co. Ltd, Tianjin, P. R. China
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3
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De Bruyne S, Steel E, Petrick M, Denys B, Vandepoele K, Van Roy N, Degandt S, Ghys T, Louagie H. Development of chronic myeloid leukemia in a patient previously diagnosed with a JAK2-positive myeloproliferative neoplasm. Clin Chem Lab Med 2021; 59:e392-e394. [PMID: 33964201 DOI: 10.1515/cclm-2020-1884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/30/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Sander De Bruyne
- Department of Laboratory Medicine, AZ Sint-Lucas, Ghent, Belgium
| | - Eva Steel
- Department of Haematology, AZ Sint-Lucas, Ghent, Belgium
| | - Marjan Petrick
- Department of Haematology, AZ Sint-Lucas, Ghent, Belgium
| | - Barbara Denys
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karl Vandepoele
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nadine Van Roy
- Department of Biomolecular Medicine, Ghent University Hospital, Ghent, Belgium
| | - Simon Degandt
- Department of Laboratory Medicine, AZ Sint-Lucas, Ghent, Belgium
| | - Timothy Ghys
- Department of Laboratory Medicine, AZ Sint-Lucas, Ghent, Belgium
| | - Henk Louagie
- Department of Laboratory Medicine, AZ Sint-Lucas, Ghent, Belgium
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Lorenzo M, Grille S, Stevenazzi M. Emergence of BCR-ABL1 Chronic Myeloid Leukemia in a JAK2-V617F Polycythemia Vera. J Hematol 2020; 9:23-29. [PMID: 32362982 PMCID: PMC7188376 DOI: 10.14740/jh591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
Emergence of a new chronic myeloid neoplasm in the setting of a previous one, or their concomitant appearance seems to be a rare event, but plenty of cases have been reported. We describe the case of a patient with JAK2-V617F polycythemia vera, which looses JAK2 clone and develops overt BCR-ABL1 chronic myeloid leukemia after 6 years. Once treatment with tyrosine kinase inhibitors controls BCR-ABL1 clone, JAK2 clone arises again. In this report, we review the literature and discuss the clonal relationship of this event in light of the new molecular data.
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Affiliation(s)
- Mariana Lorenzo
- Catedra de Hematologia, Hospital de Clinicas, Montevideo 11300, Uruguay
| | - Sofia Grille
- Catedra de Hematologia, Hospital de Clinicas, Montevideo 11300, Uruguay.,Departamento Basico de Medicina, Hospital de Clinicas, Montevideo 11300, Uruguay
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Hassankrishnamurthy S, Mody MD, Kota VK. A Case of Chronic Myelogenous Leukemia Occurring in a Patient Treated for Essential Thrombocythemia. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:10-14. [PMID: 30602717 PMCID: PMC6325661 DOI: 10.12659/ajcr.911854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Female, 49 Final Diagnosis: Essential thrombocythemia with CML Symptoms: Decreased appetite • fatigue • weight loss Medication: — Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
| | - Mayur D Mody
- Department of Internal Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Vamsi K Kota
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
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6
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De Roeck L, Michaux L, Debackere K, Lierman E, Vandenberghe P, Devos T. Coexisting driver mutations in MPN: clinical and molecular characteristics of a series of 11 patients. ACTA ACUST UNITED AC 2018; 23:785-792. [PMID: 29993347 DOI: 10.1080/10245332.2018.1498182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES CML, PV, ET and PMF are so called classical MPN with distinct clinical phenotypes. The discovery of the BCR-ABL1 translocation and mutations in driver genes JAK2, MPL and CALR has provided novel insights in their pathogenesis. While these mutations are thought to be mutually exclusive, rare cases of MPN with coexisting driver mutations have been reported. However, little is known about the clinical, biological and molecular characteristics of these patients and the interaction of the neoplastic clones. METHODS We retrospectively studied 11 MPN patients with coexisting driver mutations (JAK2 V617F + BCR-ABL1: n = 8; CALR type 2 + BCR-ABL1: n = 1; JAK2 V617F + MPL W515: n = 1; JAK2 V617F + CALR type 1: n = 1). To assess possible associated molecular aberrations, we analysed DNA of six patients using NGS. RESULTS In four CML patients, decreasing BCR-ABL1 transcript levels with increasing JAK2 V617F allele burden under TKI were observed. This strongly suggests that the coexistence of driver mutations originates from two different clones growing independently. Additional somatic mutations were detected in 5 out of 6 (83%) patients affecting 4 different genes, confirming the heterogeneity of this study cohort. Suboptimal response to TKI was observed with a higher frequency (4/8 patients) than reported in conventional series of CML and the overall tolerance of treatment with hydroxyurea and/or imatinib in our series was poor. CONCLUSION Given the emergence of NGS in clinical practice, more similar cases will be identified in the coming years. The optimal treatment strategy for this rare group of patients is uncertain and toxicity of combination treatment may have to be considered.
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Affiliation(s)
- L De Roeck
- a Department of Radiotherapy-Oncology , University Hospitals Leuven , Leuven , Belgium
| | - L Michaux
- b Center for Human Genetics , University Hospitals Leuven , Leuven , Belgium
| | - K Debackere
- c Department of Internal Medicine , University Hospitals Leuven , Leuven , Belgium
| | - E Lierman
- b Center for Human Genetics , University Hospitals Leuven , Leuven , Belgium
| | - P Vandenberghe
- b Center for Human Genetics , University Hospitals Leuven , Leuven , Belgium.,d Department of Hematology , University Hospitals Leuven , Leuven , Belgium
| | - T Devos
- d Department of Hematology , University Hospitals Leuven , Leuven , Belgium.,e Laboratory of Experimental Transplantation, Department of Microbiology and Immunology, KU Leuven , University Hospitals Leuven , Leuven , Belgium
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7
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Martin-Cabrera P, Haferlach C, Kern W, Schnittger S, Haferlach T. BCR-ABL1-positive and JAK2 V617F-positive clones in 23 patients with both aberrations reveal biologic and clinical importance. Br J Haematol 2016; 176:135-139. [PMID: 26847954 DOI: 10.1111/bjh.13932] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Tabassum N, Saboor M, Ghani R, Moinuddin M. Frequency of JAK2 V617F mutation in patients with Philadelphia positive Chronic Myeloid Leukemia in Pakistan. Pak J Med Sci 2014; 30:185-8. [PMID: 24639858 PMCID: PMC3955569 DOI: 10.12669/pjms.301.3906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 10/05/2013] [Accepted: 10/13/2013] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Co-existence of myeloproliferative disorders (MPD) and Janus associated kinase 2 mutation (JAK2 V617F) is a well-established fact. Only few case reports are available showing presence of JAK2 V617F mutation in chronic myeloid leukemia (CML). Purpose of this study was to determine the frequency of JAK2 V617F mutation in Philadelphia Chromosome positive (Ph +) CML patients in Pakistan. Methods: The study was conducted from August 2009 to July 2010 at Civil Hospital and Baqai Institute of Hematology (BIH) Karachi. Blood samples from 25 patients with CML were collected. Multiplex reverse transcription polymerase chain reaction (RT-PCR) was performed for Breakpoint Cluster Region – Abelson (BCR-ABL) rearrangement. Conventional PCR was performed for JAK2 V617F mutation on BCR-ABL positive samples. Results: All 25 samples showed BCR-ABL rearrangement. Out of these 11 samples (44%) had JAK2 V617F mutation; the remaining 14 (56%) cases showed JAK2 617V wild type. Conclusion: It is concluded that the co-existence of Ph +CML and JAK2 V617F mutation is possible.
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Affiliation(s)
- Najia Tabassum
- Najia Tabassum, Baqai Institute of Heamatology, Baqai Medical University, Karachi, Pakistan
| | - Mohammed Saboor
- Mohammed Saboor, Baqai Institute of Heamatology, Baqai Medical University, Karachi, Pakistan
| | - Rubina Ghani
- Rubina Ghani, Department of Biochemistry, Baqai Institute of Heamatology, Baqai Medical University, Karachi, Pakistan
| | - Moinuddin Moinuddin
- Moinuddin Moinuddin, Baqai Institute of Heamatology, Baqai Medical University, Karachi, Pakistan
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9
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Pastore F, Schneider S, Christ O, Hiddemann W, Spiekermann K. Impressive thrombocytosis evolving in a patient with a BCR-ABL positive CML in major molecular response during dasatinib treatment unmasks an additional JAK2V617F. Exp Hematol Oncol 2013; 2:24. [PMID: 24007855 PMCID: PMC3847069 DOI: 10.1186/2162-3619-2-24] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 08/31/2013] [Indexed: 12/31/2022] Open
Abstract
We present a case of a 42-year old female with the rare diagnosis of a myeloproliferative syndrome harboring both a BCR-ABL transclocation and a JAK2V617F mutation. Initially diagnosed with a CML, the patient underwent treatment with imatinib followed by dasatinib. Despite a major molecular response, the patient developed a thrombocytosis. Molecular analyses revealed a heterozygous JAK2V617F mutation, which was detected retrospectively in the bone marrow at the time of CML diagnosis. This case underlines the complexity of MPS pathogenesis. For the clinician, a JAK2 mutational screening should be performed in CML patients without hematological response in the absence of BCR-ABL.
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Affiliation(s)
- Friederike Pastore
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, University Hospital Munich - Campus Grosshadern, Munich, Germany.
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10
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Harrison CN, Butt N, Campbell P, Conneally E, Drummond M, Green AR, Murrin R, Radia DH, Reilly JT, McMullin MF. Diagnostic pathway for the investigation of thrombocytosis. Br J Haematol 2013; 161:604-6. [DOI: 10.1111/bjh.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claire N. Harrison
- Department of Haematology; Guy's and St Thomas, Hospitals' NHS Foundation Trust; London UK
| | - Nauman Butt
- Department of Haematology; Arrowe Park Hospital; Wirral UK
| | - Peter Campbell
- Welcome Trust Sanger Institute; Welcome Trust Genome Campus; Hinxton Cambridge UK
| | | | - Mark Drummond
- Department of Haematology; Beatson Oncology Centre; Glasgow UK
| | - Anthony R. Green
- Department of Haematology; Cambridge Institute for Medical Research; Cambridge UK
| | | | - Deepti H. Radia
- Department of Haematology; Guy's and St Thomas, Hospitals' NHS Foundation Trust; London UK
| | | | - Mary F. McMullin
- Department of Haematology; CCRCB; Queen's University; Belfast UK
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11
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Weng WH, Shih LY. Occurrence of BCR-ABL1-positive chronic myeloid leukemia following essential thrombocythemia. Acta Haematol 2011; 126:220-3. [PMID: 21934297 DOI: 10.1159/000330524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/26/2011] [Indexed: 11/19/2022]
MESH Headings
- Adult
- Antineoplastic Agents/therapeutic use
- Fusion Proteins, bcr-abl/blood
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Protein Kinase Inhibitors/therapeutic use
- Recurrence
- Thrombocythemia, Essential/blood
- Thrombocythemia, Essential/complications
- Thrombocythemia, Essential/drug therapy
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Wei-Hung Weng
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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12
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Toogeh G, Ferdowsi S, Naadali F, Alimoghaddam K, Ghavamzadeh A, Shirkoohi R, Ghaffari SH. Concomitant presence of JAK2 V617F mutation and BCR-ABL translocation in a pregnant woman with polycythemia vera. Med Oncol 2010; 28:1555-8. [PMID: 20499211 DOI: 10.1007/s12032-010-9570-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/10/2010] [Indexed: 01/09/2023]
Abstract
In 2007, a 27-year-old woman presented with mild splenomegaly. Blood counts showed hemoglobin (Hb): 17.8 g/dl, HCT: 56% and Red blood cells: 6.45×10(12)/L. Bone marrow examination disclosed a hypercellular marrow. Molecular analysis showed the presence of the JAK2 V617F mutation and BCR-ABL/BCR mRNA b3a2 transcript. A diagnosis of BCR-ABL-positive polycythemia vera (PV) was made. In 2009, she had nulipar pregnancy and treated with interferon-alpha. She delivered a healthy girl infant at 37 weeks. This case report suggests that in a PV pregnant woman with a concomitant presence of JAK2 V617F mutation and BCR-ABL translocation, the administration of interferon during the pregnancy could lead to a safe pregnancy and delivery.
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Affiliation(s)
- Gholamreza Toogeh
- Hematology-Oncology and BMT Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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13
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Pingali SRK, Mathiason MA, Lovrich SD, Go RS. Emergence of chronic myelogenous leukemia from a background of myeloproliferative disorder: JAK2V617F as a potential risk factor for BCR-ABL translocation. ACTA ACUST UNITED AC 2010; 9:E25-9. [PMID: 19858050 DOI: 10.3816/clm.2009.n.080] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the emergence of chronic myelogenous leukemia (CML) in a patient with JAK2V617F-positive polycythemia vera after 15 years of phlebotomy. The polycythemia vera clinical and molecular findings were suppressed at the time of CML diagnosis, only to re-emerge after the leukemia was successfully treated with imatinib. We explored the potential association between myeloproliferative disorders and CML in the context of the current literature and found a higher-than-expected coincidence based on known epidemiologic data for each specific condition. We hypothesize that myeloproliferative disorder (JAK2V617F or molecular events that cause JAK2V617F) is a risk factor for CML (BCR-ABL translocation). Because of therapeutic implications, clinicians should be aware that the conditions co-occur more frequently than once thought.
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Affiliation(s)
- Sai Ravi Kiran Pingali
- Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA
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14
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Emergence of chronic myelogenous leukemia during treatment for essential thrombocythemia. Int J Hematol 2010; 91:516-21. [PMID: 20146031 DOI: 10.1007/s12185-010-0502-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 12/26/2009] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
Abstract
A 72-year-old male patient was initially diagnosed with essential thrombocythemia (ET), a Philadelphia chromosome-negative (Ph1(-)) chronic myeloproliferative disorder (CMPD), and was treated with hydroxyurea (HU). After 9 years of diagnosis of ET, his peripheral leukocytes gradually increased, while his platelet count showed a decrease. Bone marrow analysis disclosed Ph-positive chronic myelogenous leukemia (CML) in the chronic phase. Administration of imatinib mesylate (IM), a Bcr-Abl tyrosine kinase inhibitor (TKI), induced complete hematologic response in a month, but was discontinued after 4 months because of Grade 3 pleural effusion (PE). The treatment was switched to nilotinib which successfully induced a complete cytogenetic response (CCyR) after 5 months of TKI therapy and resolved the PE. Despite CCyR, however, ET recurred. Since then, the patient has been treated for 8 months with a combination of nilotinib and HU which has successfully controlled both CML and ET. This report includes a review of the characteristics of 15 reported cases with co-occurrence of CML and Bcr-Abl-negative CMPDs, including ours. Although rare, care needs to be taken since, despite the often similar clinical features of the two diseases, they require completely different treatments.
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15
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Campiotti L, Appio L, Solbiati F, Ageno W, Venco A. JAK2-V617F mutation and Philadelphia positive chronic myeloid leukemia. Leuk Res 2009; 33:e212-3. [PMID: 19589593 DOI: 10.1016/j.leukres.2009.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 06/08/2009] [Accepted: 06/09/2009] [Indexed: 12/13/2022]
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16
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Krämer A. JAK2-V617F and BCR-ABL—Double Jeopardy? Leuk Res 2008; 32:1489-90. [DOI: 10.1016/j.leukres.2008.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 11/27/2022]
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17
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Jallades L, Hayette S, Tigaud I, Johnston A, Coiffier B, Magaud JP, Ffrench M. Emergence of therapy-unrelated CML on a background of BCR-ABL-negative JAK2V617F-positive chronic idiopathic myelofibrosis. Leuk Res 2008; 32:1608-10. [PMID: 18448166 DOI: 10.1016/j.leukres.2008.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 11/16/2022]
Abstract
We report the emergence of a chronic myeloid leukaemia (CML) during the course of a JAK2V617F-positive chronic idiopathic myelofibrosis (CIMF) in the absence of any myelosuppressive treatment. Although a response to imatinib was observed, the underlying myelofibrosis persisted after treatment and hydroxyurea was finally added to control the persistent thrombocytosis. Such rare patients with co-existing BCR-ABL translocation and JAK2V617F mutation must be identified in view of the possibility of targeted therapies. Moreover, the detection of BCR-ABL translocation appears to be crucial especially in the case of treated CIMF with an atypical course to identify CML before acute transformation.
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Affiliation(s)
- Laurent Jallades
- Laboratoire d'Hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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18
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Kim YK, Shin MG, Kim HR, Yang DH, Cho SH, Lee JJ, Chung IJ, Ryang DW, Kim HJ. Simultaneous occurrence of the JAK2V617F mutation and BCR-ABL gene rearrangement in patients with chronic myeloproliferative disorders. Leuk Res 2007; 32:993-5. [PMID: 18055011 DOI: 10.1016/j.leukres.2007.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 10/23/2007] [Accepted: 10/25/2007] [Indexed: 11/16/2022]
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19
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Mirza I, Frantz C, Clarke G, Voth AJ, Turner R. Transformation of polycythemia vera to chronic myelogenous leukemia. Arch Pathol Lab Med 2007; 131:1719-24. [PMID: 17979493 DOI: 10.5858/2007-131-1719-topvtc] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2007] [Indexed: 11/06/2022]
Abstract
Transformation of polycythemia vera to chronic myelogenous leukemia is a rare event. We report 2 women with long-standing polycythemia vera who developed chronic myelogenous leukemia. Both patients had no BCR/ABL1 fusion at the time of polycythemia vera diagnosis but were positive for the fusion at chronic myelogenous leukemia onset. Most patients with polycythemia vera have JAK2(V617F) mutation. Analysis of an archival bone marrow aspirate sample from 1 patient showed a heterozygous mutation status. The blood and bone marrow samples from the other patient showed the presence of homozygous JAK2(V617F) mutation and BCR/ABL1 fusion. The possible pathogenesis of such an event is discussed in the light of current literature.
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Affiliation(s)
- Imran Mirza
- Department of Laboratory Medicine and Pathology, University of Alberta, 8440 112th St, Edmonton, Alberta, Canada T6M 2E7.
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Go RS. Myeloproliferative disorders with coexisting BCR-ABL translocation and JAK2V617F mutation. Leukemia 2007; 21:2051; author reply 2052. [PMID: 17597806 DOI: 10.1038/sj.leu.2404825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Krämer A, Reiter A, Kruth J, Erben P, Hochhaus A, Müller M, Cross NCP, Jones AV, Ho AD, Hensel M. JAK2-V617F mutation in a patient with Philadelphia-chromosome-positive chronic myeloid leukaemia. Lancet Oncol 2007; 8:658-60. [PMID: 17613428 DOI: 10.1016/s1470-2045(07)70206-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alwin Krämer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg Germany.
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22
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Reply to ‘Myeloproliferative disorders with coexisting BCR-ABL translocation and JAK2V617F mutation’ by Dr Ronald S Go. Leukemia 2007. [DOI: 10.1038/sj.leu.2404826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Brusa G, Zuffa E, Mancini M, Benvenuti M, Calonghi N, Barbieri E, Santucci MA. P210 Bcr-abl tyrosine kinase interaction with histone deacetylase 1 modifies histone H4 acetylation and chromatin structure of chronic myeloid leukaemia haematopoietic progenitors. Br J Haematol 2006; 132:359-69. [PMID: 16409301 DOI: 10.1111/j.1365-2141.2005.05873.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The BCR-ABL fusion gene, originating from the balanced (9;22) translocation, is the molecular hallmark and the causative event of chronic myeloid leukaemia (CML). The interactions of its p210 protein constitutively activated and improperly confined to the cytoplasm with multiple regulatory signals of cell cycle progression, apoptosis and self-renewal, induce the illegitimate enlargement of clonal haematopoiesis and genetic instability that drives its progression towards the fully transformed phenotype of blast crisis. However, its effects on the basic transcription machinery and chromatin remodelling are unknown. Our study underscored histone H4 hyperacetylation associated with p210 tyrosine kinase in vitro and in vivo and its role in BCR-ABL transcription. Histone H4 hyperacetylation proceeds, at least partly, from the 'loss of function' of histone deacetylase 1 protein, a critical component of Rb-mediated transcriptional repression, in consequence of its cytoplasmatic compartmentalisation.
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MESH Headings
- Acetylation
- Antigens, CD34/immunology
- Cell Line
- Cell Line, Tumor
- Chromatin/chemistry
- Cytoplasm/metabolism
- Fusion Proteins, bcr-abl
- Gene Expression Regulation, Neoplastic/genetics
- Gene Expression Regulation, Neoplastic/immunology
- Hematopoietic Stem Cells/immunology
- Hematopoietic Stem Cells/metabolism
- Histone Deacetylase 1
- Histone Deacetylases/metabolism
- Histones/metabolism
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
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Affiliation(s)
- Gianluca Brusa
- Istituto di Ematologia e Oncologia Medica Lorenzo e Ariosto Seràgnoli, Universita di Bologna, Bologna, Italy.
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Scott LM, Campbell PJ, Baxter EJ, Todd T, Stephens P, Edkins S, Wooster R, Stratton MR, Futreal PA, Green AR. The V617F JAK2 mutation is uncommon in cancers and in myeloid malignancies other than the classic myeloproliferative disorders. Blood 2005; 106:2920-1. [PMID: 16204151 DOI: 10.1182/blood-2005-05-2087] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Essential thrombocythaemia was first described over 70 years ago. This condition is dominated by thrombotic and haemorrhagic complications and, in the long-term, by risk of transformation to myelofibrosis and/or acute leukaemia. However, it is heterogeneous both clinically and biologically. Here, a review of current concepts in disease aetiology and management is offered with reference to recent focused reviews where appropriate. In addition, five specific areas are discussed in detail: the role of the trephine biopsy, the disease entity prefibrotic myelofibrosis; the recently described Janus kinase 2 (JAK2) mutations; the leukaemogenicity of hydroxyurea (hydroxycarbamide); and lastly, the implications of the results of the Medical Research Council Primary Thrombocythaemia 1 study are explored.
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Affiliation(s)
- Claire N Harrison
- Department of Haematology, St Thomas Hospital, Lambeth Palace Road, London, UK.
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Campbell PJ, Green AR. Management of polycythemia vera and essential thrombocythemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2005:201-8. [PMID: 16304381 DOI: 10.1182/asheducation-2005.1.201] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The optimal management of patients with polycythemia vera (PV) and essential thrombocythemia (ET) continues to be controversial. Both diseases present diagnostic challenges and there is a paucity of data from randomized clinical trials to guide therapeutic decisions. However, the past two years have seen major advances in our understanding of these myeloproliferative disorders (MPD). First, the ECLAP study demonstrated the anti-thrombotic efficacy of aspirin in patients with PV. Second, the PT-1 trial, the largest randomized study of any MPD, has provided much needed guidance on the optimal management of patients with ET. Third, the identification of a single JAK2 mutation in most patients with PV, and in some of those with ET, illuminates the pathogenesis of these diseases and raises questions about the boundary between them. For the purpose of management decisions, it remains appropriate to consider them as separate entities for the time being. However, as we learn more about the clinical significance of the JAK2 mutation, it seems likely that the coming years will see major changes in the way we classify and manage these disorders.
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Affiliation(s)
- Peter J Campbell
- University of Cambridge Department of Haematology, Cambridge Institute for Medical Research, Cambridge, CB2 2XY, UK
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