1
|
Wu HC, de Thé H. Tripartite RAR fusions explain RA resistance. Blood 2024; 144:1461-1462. [PMID: 39361303 DOI: 10.1182/blood.2024026117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Affiliation(s)
- Hsin-Chieh Wu
- Université Paris Cité
- INSERM
- Centre National de la Recherche Scientifique
| | - Hugues de Thé
- Université Paris Cité
- INSERM
- Centre National de la Recherche Scientifique
- Collège de France
- Université Paris Sorbonne Lettres
- Assistance Publique-Hôpital St. Louis
| |
Collapse
|
2
|
Zhou X, Chen X, Chen J, Wen L, Zhang Z, Qin YZ, Cao P, Xing H, Mi Y, Wang W, Zhang G, Li J, Wu H, Zhang Z, Zhang J, Su Z, Wang F, Zhang Y, Ma X, Fang J, Wu P, Wang T, Fan G, Zhao Y, Jin D, Zhang X, Ma X, Wu Q, Zhang Z, Wang L, Ma F, Xiao X, Wu C, Sun K, Tang R, Zhang Y, Wu S, Gao R, Zhang L, Zheng H, Zhao Y, Zhu HH, Lu D, Lu P, Chen S, Liu H. Critical role of tripartite fusion and LBD truncation in certain RARA- and all RARG-related atypical APL. Blood 2024; 144:1471-1485. [PMID: 39046762 DOI: 10.1182/blood.2024023883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/18/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024] Open
Abstract
ABSTRACT Atypical acute promyelocytic leukemia (aAPL) presents a complex landscape of retinoic acid receptor (RAR) fusion genes beyond the well-known PML::RARA fusion. Among these, 31 individually rare RARA and RARG fusion genes have been documented, often reported in the canonical X::RAR bipartite fusion form. Intriguingly, some artificially mimicked bipartite X::RAR fusions respond well to all-trans retinoic acid (ATRA) in vitro, contrasting with the ATRA resistance observed in patients. To unravel the underlying mechanisms, we conducted a comprehensive molecular investigation into the fusion transcripts in 27 RARA fusion gene-positive aAPL (RARA-aAPL) and 21 RARG-aAPL cases. Our analysis revealed an unexpected novel form of X::RAR::X- or X::RAR::Y-type tripartite fusions in certain RARA-aAPL and all RARG-aAPL cases, with shared features and notable differences between these 2 disease subgroups. In RARA-aAPL cases, the occurrence of RARA 3' splices was associated with their 5' fusion partner genes, mapping across the coding region of helix 11_12 (H11_12) within the ligand-binding domain (LBD), resulting in LBD-H12 or H11_12 truncation. In RARG-aAPL cases, RARG 3' splices were consistently localized to the terminus of exon 9, leading to LBD-H11_12 truncation. Significant differences were also observed between RARA and RARG 5' splice patterns. Our analysis also revealed extensive involvement of transposable elements in constructing RARA and RARG 3' fusions, suggesting transposition mechanisms for fusion gene ontogeny. Both protein structural analysis and experimental results highlighted the pivotal role of LBD-H11_12/H12 truncation in driving ATRA unresponsiveness and leukemogenesis in tripartite fusion-positive aAPL, through a protein allosteric dysfunction mechanism.
Collapse
MESH Headings
- Humans
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Leukemia, Promyelocytic, Acute/pathology
- Retinoic Acid Receptor alpha/genetics
- Retinoic Acid Receptor alpha/metabolism
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Retinoic Acid Receptor gamma
- Receptors, Retinoic Acid/genetics
- Receptors, Retinoic Acid/metabolism
- Male
- Tretinoin/metabolism
- Female
Collapse
Affiliation(s)
- Xiaosu Zhou
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
| | - Xue Chen
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Jiaqi Chen
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Lijun Wen
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Zhanglin Zhang
- Department of Blood Transfusion, First Affiliated Hospital of Nanchang University, Jiangxi Key Laboratory of transfusion, Institute of Transfusion, Jiangxi Academy of Clinical Medical Sciences, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ya-Zhen Qin
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Panxiang Cao
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Haizhou Xing
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingchang Mi
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Wei Wang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guangsen Zhang
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huanling Wu
- Department of Clinical Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhifen Zhang
- Department of Clinical Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jian Zhang
- Department of Clinical Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhan Su
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fang Wang
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Yang Zhang
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xiaoli Ma
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Jiancheng Fang
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Ping Wu
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Division of Pathology and Laboratory Medicine, Beijing Lu Daopei Hospital, Beijing, China
| | - Tong Wang
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Division of Pathology and Laboratory Medicine, Beijing Lu Daopei Hospital, Beijing, China
| | - Gaowei Fan
- Department of Clinical Laboratory, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - David Jin
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
| | - Xian Zhang
- Department of Hematology, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xiujuan Ma
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Qisheng Wu
- Division of Pathology and Laboratory Medicine, Beijing Lu Daopei Hospital, Beijing, China
| | - Zhihua Zhang
- Department of Hematology, The Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Linya Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Futian Ma
- Department of Hematology, Hebei Children's Hospital, Shijiazhuang, China
| | - Xia Xiao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, China
| | - Chengye Wu
- Institute of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Kai Sun
- Department of Hematology, Beijing Ji-Shui-Tan Hospital, Capital Medical University, Beijing, China
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Ruijie Tang
- Department of Hematology, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Yun Zhang
- Department of Clinical Laboratory, The People's Hospital of Zhangqiu District, Jinan, China
| | - Sanyun Wu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ran Gao
- Department of Hematology, The First Hospital of China Medical University, Shenyang, China
| | - Leping Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Huyong Zheng
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanli Zhao
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Hong-Hu Zhu
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Daopei Lu
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Department of Hematology, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Department of Hematology, Beijing Lu Daopei Hospital, Beijing, China
- Department of Oncology, Capital Medical University, Beijing, China
| | - Peihua Lu
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Department of Hematology, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Department of Hematology, Beijing Lu Daopei Hospital, Beijing, China
- Department of Oncology, Capital Medical University, Beijing, China
| | - Suning Chen
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Hongxing Liu
- Precision Medicine Center, Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
- Division of Pathology and Laboratory Medicine, Beijing Lu Daopei Hospital, Beijing, China
- Department of Oncology, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Frazzetto S, Gullo L, Sapuppo G, Fazio M, Lo Faro C, Giunta G, Caravotta I, Mauro E, Parisi MS, Triolo AM, Parrinello NL, Consoli ML, També L, Cambria D, Marino S, Scuderi G, Di Raimondo F. Three-Way Translocation t(12;15;17) (p13;q24;q21) Found in Acute Promyelocytic Leukemia with Basophilic Differentiation. Hematol Rep 2024; 16:367-374. [PMID: 38921185 PMCID: PMC11203485 DOI: 10.3390/hematolrep16020037] [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: 04/13/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Acute promyelocytic leukemia is a rare form of acute myeloid leukemia in which immature promyelocytes abnormally proliferate in the bone marrow. In most cases, the disease is characterised by the translocation t(15;17) (q24;q21), which causes the formation of PML::RARA, an oncogenic fusion protein responsible for blocking myeloid differentiation and survival advantage. Here, we present a case of acute promyelocytic leukemia with two unusual features: basophilic differentiation and a three-way translocation involving chromosomes 12, 15 and 17. In the few cases reported, basophilic differentiation was associated with a poor prognosis. In contrast, our patient responded promptly to the standard treatment with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) and obtained complete remission. To our knowledge, this is the first report of basophilic acute promyelocytic leukemia with the three-way translocation t(12;17;15) (p13; q24;q21).
Collapse
Affiliation(s)
- Sara Frazzetto
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Lara Gullo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Gabriele Sapuppo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Manlio Fazio
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Cristina Lo Faro
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Giuliana Giunta
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Ignazio Caravotta
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| | - Elisa Mauro
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Marina Silvia Parisi
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Anna Maria Triolo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Nunziatina Laura Parrinello
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Maria Letizia Consoli
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Loredana També
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Daniela Cambria
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Sara Marino
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Grazia Scuderi
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-San Marco, 95123 Catania, Italy; (L.G.); (G.S.); (M.F.); (C.L.F.); (G.G.); (I.C.); (E.M.); (M.S.P.); (A.M.T.); (N.L.P.); (M.L.C.); (L.T.); (D.C.); (S.M.); (G.S.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy
| |
Collapse
|
4
|
Travaglini S, Marinoni M, Visconte V, Guarnera L. Therapy-Related Myeloid Neoplasm: Biology and Mechanistic Aspects of Malignant Progression. Biomedicines 2024; 12:1054. [PMID: 38791019 PMCID: PMC11118122 DOI: 10.3390/biomedicines12051054] [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: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Therapy-related myeloid neoplasms (t-MN) arise after a documented history of chemo/radiotherapy as treatment for an unrelated condition and account for 10-20% of myelodysplastic syndromes and acute myeloid leukemia. T-MN are characterized by a specific genetic signature, aggressive features and dismal prognosis. The nomenclature and the subsets of these conditions have changed frequently over time, and despite the fact that, in the last classification, they lost their autonomous entity status and became disease qualifiers, the recognition of this feature remains of major importance. Furthermore, in recent years, extensive studies focusing on clonal hematopoiesis and germline variants shed light on the mechanisms of positive pressure underpinning the rise of driver gene mutations in t-MN. In this manuscript, we aim to review the evolution of defining criteria and characteristics of t-MN from a clinical and biological perspective, the advances in mechanistic aspects of malignant progression and the challenges in prevention and management.
Collapse
Affiliation(s)
- Serena Travaglini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Massimiliano Marinoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Valeria Visconte
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Luca Guarnera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| |
Collapse
|
5
|
Jiang M, Wang X, Yu M, Jiang S, Hong M, Zhou Y, Li F, Liu H, Zhang Z. Report of IRF2BP1 as a novel partner of RARA in variant acute promyelocytic leukemia. Am J Hematol 2024; 99:1005-1007. [PMID: 38410879 DOI: 10.1002/ajh.27272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 02/28/2024]
Abstract
IRF2BP1 breaked in the middle of exon 1 at the c.322 position and fused with RARA intron 2 which is located at 3717 bp upstream of its exon 3. The fusion produced a new intron by forming a paired splicing donor GT at 9 bp downstream of RARA breakpoint and acceptor AG at the 5' end of RARA exon 3. The IRF2BP1::RARA fusion gene leads a fusion transcript involving IRF2BP1 exon 1 and RARA exon 3, linked by a 9-bp fragment derived from RARA intron 2. The patient with IRF2BP1::RARA has same clinical features of APL.
Collapse
Affiliation(s)
- Mei Jiang
- Department of Clinical Laboratory, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xuemei Wang
- Department of Blood Transfusion, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Min Yu
- Department of Hematology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Shuling Jiang
- Nursing School of Nanchang University, Nanchang, China
| | - Miao Hong
- Department of Blood Transfusion, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yuru Zhou
- Department of Blood Transfusion, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fei Li
- Department of Hematology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Hongxing Liu
- Department of Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Zhanglin Zhang
- Department of Blood Transfusion, Institute of transfusion, Jiangxi Key Laboratory of transfusion, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| |
Collapse
|
6
|
Liu FS, Huang HL. Case report: One case of acute myeloid leukemia M3 with atypical morphology. Front Oncol 2024; 14:1341840. [PMID: 38567145 PMCID: PMC10985165 DOI: 10.3389/fonc.2024.1341840] [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: 11/21/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Acute promyelocytic leukemia (APL) is a type of acute myeloid leukemia. About 2% of APL is characterized by atypical rearrangements. Here we reported one APL case with atypical manifestations and morphology. A 35-year-old woman patient, mainly due to fatigue, poor appetite for over 10 days and intermittent fever for 3 days. combined with the results of flow cytometry, fusion gene and chromosome, the patient was diagnosed as AML-M3 with atypical morphology. Double induction therapy with retinoic acid and arsenous acid was immediately administrated. Idarubicin was administrated on the 18th day. A re-examination was performed in the 5th week, both the blood routine test and myelogram showed normal results, and the fusion gene turned negative, indicating complete remission. When atypical morphology occurs, peripheral blood POX staining may be performed to check the abnormal cells. Flow cytometry, chromosome analysis, and fusion gene analysis are also required for further diagnosis.
Collapse
Affiliation(s)
| | - Hua-Liang Huang
- Department of Laboratory, Inner Mongolia Baogang Hospital, Baotou, China
| |
Collapse
|
7
|
Snaith O, Poveda-Rogers C, Laczko D, Yang G, Morrissette JJD. Cytogenetics and genomics of acute myeloid leukemia. Best Pract Res Clin Haematol 2024; 37:101533. [PMID: 38490763 DOI: 10.1016/j.beha.2023.101533] [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: 02/28/2023] [Revised: 09/14/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024]
Abstract
The diversity of genetic and genomic abnormalities observed in acute myeloid leukemia (AML) reflects the complexity of these hematologic neoplasms. The detection of cytogenetic and molecular alterations is fundamental to diagnosis, risk stratification and treatment of AML. Chromosome rearrangements are well established in the diagnostic classification of AML, as are some gene mutations, in several international classification systems. Additionally, the detection of new mutational profiles at relapse and identification of mutations in the pre- and post-transplant settings are illuminating in understanding disease evolution and are relevant to the risk assessment of AML patients. In this review, we discuss recurrent cytogenetic abnormalities, as well as the detection of recurrent mutations, within the context of a normal karyotype, and in the setting of chromosome abnormalities. Two new classification schemes from the WHO and ICC are described, comparing these classifications in terms of diagnostic criteria and entity definition in AML. Finally, we discuss ways in which genomic sequencing can condense the detection of gene mutations and chromosome abnormalities into a single assay.
Collapse
Affiliation(s)
- Oraine Snaith
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Corey Poveda-Rogers
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Dorottya Laczko
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Guang Yang
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer J D Morrissette
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
8
|
Yokoyama Y. Risk factors and remaining challenges in the treatment of acute promyelocytic leukemia. Int J Hematol 2024:10.1007/s12185-023-03696-7. [PMID: 38386203 DOI: 10.1007/s12185-023-03696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/23/2024]
Abstract
The treatment of acute promyelocytic leukemia (APL) has evolved with the introduction of all-trans retinoic acid (ATRA) and subsequent arsenic trioxide (ATO), particularly in standard-risk APL with an initial white blood cell count (WBC) < 10,000/μL, where a high cure rate can now be achieved. However, for some patients with risk factors, early death or relapse remains a concern. Insights from the analysis of patients treated with ATRA and chemotherapy have identified risk factors such as WBC, surface antigens, complex karyotypes, FLT3 and other genetic mutations, p73 isoforms, variant rearrangements, and drug resistance mutations. However, in the ATRA + ATO era, the significance of these risk factors is changing. This article provides a comprehensive review of APL risk factors, taking into account the treatment approach, and explores the challenges associated with APL treatments.
Collapse
Affiliation(s)
- Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| |
Collapse
|
9
|
Guarnera L, Santinelli E, Galossi E, Cristiano A, Fabiani E, Falconi G, Voso MT. Microenvironment in acute myeloid leukemia: focus on senescence mechanisms, therapeutic interactions, and future directions. Exp Hematol 2024; 129:104118. [PMID: 37741607 DOI: 10.1016/j.exphem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Acute myeloid leukemia (AML) is a disease with a dismal prognosis, mainly affecting the elderly. In recent years, new drugs have improved life expectancy and quality of life, and a better understanding of the genetic-molecular nature of the disease has shed light on previously unknown aspects of leukemogenesis. In parallel, increasing attention has been attracted to the complex interactions between cells and soluble factors in the bone marrow (BM) environment, collectively known as the microenvironment. In this review, we discuss the central role of the microenvironment in physiologic and pathologic hematopoiesis and the mechanisms of senescence, considered a fundamental protective mechanism against the proliferation of damaged and pretumoral cells. The microenvironment also represents a fertile ground for the development of myeloid malignancies, and the leukemic niche significantly interacts with drugs commonly used in AML treatment. Finally, we focus on the role of the microenvironment in the engraftment and complications of allogeneic hematopoietic stem cell transplantation, the only curative option in a conspicuous proportion of patients.
Collapse
Affiliation(s)
- Luca Guarnera
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Enrico Santinelli
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Elisa Galossi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Antonio Cristiano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Saint Camillus International, University of Health Sciences, Rome, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Neuro-Oncohematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy.
| |
Collapse
|
10
|
Borsellino B, Bravo-Perez C, Visconte V, Guarnera L. Thrombosis in Myeloid Malignancies: From CHIP to AML. Cardiovasc Hematol Disord Drug Targets 2024; 24:2-12. [PMID: 38879768 DOI: 10.2174/011871529x307253240530060107] [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: 01/29/2024] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 09/04/2024]
Abstract
The development of myeloid malignancies is a multi-step process starting from pre-malignant stages. Large-scale studies on clonal hematopoiesis of indeterminate potential (CHIP) identified this condition as a risk factor for developing hematologic malignancies, in particular myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). In parallel, CHIP was found to confer an enhanced thrombotic risk, in particular for cardiovascular diseases. In a similar fashion, in recent years, alongside their life-threatening features, increasing attention has been drawn toward thrombotic complications in myeloid malignancies. Thus, the purpose of this review is to gather a growing body of evidence on incidence, pathogenesis and clinical impact of thrombosis in myeloid malignancies at every step of malignant progression, from CHIP to AML.
Collapse
Affiliation(s)
- Beatrice Borsellino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, 00133, Italy
| | - Carlos Bravo-Perez
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH44195, USA
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, IMIB-Pascual Parrilla, CIBERER-Instituto de Salud Carlos III, 30005, Murcia, Spain
| | - Valeria Visconte
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH44195, USA
| | - Luca Guarnera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, 00133, Italy
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH44195, USA
| |
Collapse
|
11
|
Ghiaur A, Ghiaur G. Charting a course through the acute promyelocytic leukemia (APL)-like nebula: the enigmatic cousins of APL. Haematologica 2023; 108:2886-2888. [PMID: 37288506 PMCID: PMC10620559 DOI: 10.3324/haematol.2023.283232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
|
12
|
Guarnera L, Bravo-Perez C, Visconte V. Immunotherapy in Acute Myeloid Leukemia: A Literature Review of Emerging Strategies. Bioengineering (Basel) 2023; 10:1228. [PMID: 37892958 PMCID: PMC10604866 DOI: 10.3390/bioengineering10101228] [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: 09/15/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
In the last twenty years, we have witnessed a paradigm shift in the treatment and prognosis of acute myeloid leukemia (AML), thanks to the introduction of new efficient drugs or approaches to refine old therapies, such as Gemtuzumab Ozogamicin, CPX 3-5-1, hypomethylating agents, and Venetoclax, the optimization of conditioning regimens in allogeneic hematopoietic stem cell transplantation and the improvement of supportive care. However, the long-term survival of non-M3 and non-core binding factor-AML is still dismal. For this reason, the expectations for the recently developed immunotherapies, such as antibody-based therapy, checkpoint inhibitors, and chimeric antigen receptor strategies, successfully tested in other hematologic malignancies, were very high. The inherent characteristics of AML blasts hampered the development of these treatments, and the path of immunotherapy in AML has been bumpy. Herein, we provide a detailed review of potential antigenic targets, available data from pre-clinical and clinical trials, and future directions of immunotherapies in AML.
Collapse
Affiliation(s)
- Luca Guarnera
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.B.-P.); (V.V.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Carlos Bravo-Perez
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.B.-P.); (V.V.)
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, IMIB-Pascual Parrilla, CIBERER—Instituto de Salud Carlos III, 30005 Murcia, Spain
| | - Valeria Visconte
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.B.-P.); (V.V.)
| |
Collapse
|
13
|
Bidet A, Quessada J, Cuccuini W, Decamp M, Lafage-Pochitaloff M, Luquet I, Lefebvre C, Tueur G. Cytogenetics in the management of acute myeloid leukemia and histiocytic/dendritic cell neoplasms: Guidelines from the Groupe Francophone de Cytogénétique Hématologique (GFCH). Curr Res Transl Med 2023; 71:103421. [PMID: 38016419 DOI: 10.1016/j.retram.2023.103421] [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: 07/04/2023] [Revised: 09/29/2023] [Accepted: 10/15/2023] [Indexed: 11/30/2023]
Abstract
Genetic data are becoming increasingly essential in the management of hematological neoplasms as shown by two classifications published in 2022: the 5th edition of the World Health Organization Classification of Hematolymphoid Tumours and the International Consensus Classification of Myeloid Neoplasms and Acute Leukemias. Genetic data are particularly important for acute myeloid leukemias (AMLs) because their boundaries with myelodysplastic neoplasms seem to be gradually blurring. The first objective of this review is to present the latest updates on the most common cytogenetic abnormalities in AMLs while highlighting the pitfalls and difficulties that can be encountered in the event of cryptic or difficult-to-detect karyotype abnormalities. The second objective is to enhance the role of cytogenetics among all the new technologies available in 2023 for the diagnosis and management of AML.
Collapse
Affiliation(s)
- Audrey Bidet
- Laboratoire d'Hématologie Biologique, CHU Bordeaux, Avenue Magellan, Bordeaux, Pessac F-33600, France.
| | - Julie Quessada
- Laboratoire de Cytogénétique Hématologique, Hôpital des enfants de la Timone, Assistance Publique-Hôpitaux de Marseille (APHM), Faculté de Médecine, Aix Marseille Université, Marseille 13005, France; CNRS, INSERM, CIML, Aix Marseille Université, Marseille 13009, France
| | - Wendy Cuccuini
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Marina Lafage-Pochitaloff
- Laboratoire de Cytogénétique Hématologique, Hôpital des enfants de la Timone, Assistance Publique-Hôpitaux de Marseille (APHM), Faculté de Médecine, Aix Marseille Université, Marseille 13005, France
| | - Isabelle Luquet
- Laboratoire d'Hématologie, CHU Toulouse, Site IUCT-O, Toulouse, France
| | - Christine Lefebvre
- Unité de Génétique des Hémopathies, Service d'Hématologie Biologique, CHU Grenoble Alpes, Grenoble, France
| | - Giulia Tueur
- Laboratoire d'Hématologie, CHU Avicenne, APHP, Bobigny, France
| |
Collapse
|
14
|
Wu H, Li H, Zhou X, Zhao Z, Cao P, Li L, Ma X, Yuan L, Wang F, Zhang Y, Chen J, Fang J, Liu M, Liu M, Chen X, Liu H. Report of PRPF19 as a novel partner of RARG and the recurrence of interposition-type fusion in variant acute promyelocytic leukemia. Hematol Oncol 2023; 41:784-788. [PMID: 37132198 DOI: 10.1002/hon.3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia (AML) which is characterized by specific clinical and biological features. Typical APL cases are caused by PML::RARA fusion gene and are exquisitely sensitive to all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Rarely, APLs are caused by atypical fusions involving RARA or, in fewer cases still, fusions involving other members of the retinoic acid receptors (RARB or RARG). To date, seven partner genes of RARG have been reported in a total of 18 cases of variant APL. Patients with RARG fusions showed distinct clinical resistance to ATRA and had poor outcomes. Here, we report PRPF19 gene as a novel partner of RARG and identify a rare interposition-type gene fusion in a variant APL patient with a rapidly fatal clinical course. The incomplete ligand-binding domain of RARG in the fusion protein may account for the clinical ATRA resistance in this patient. These results broaden the spectrum of variant APL associated molecular aberrations. Accurately and timely identification of these rare gene fusions in variant APL is essential to guide therapeutic decisions.
Collapse
Affiliation(s)
- Huanling Wu
- Department of Clinical Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongjun Li
- Emergency Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaosu Zhou
- Beijing Lu Daopei Institute of Hematology, Beijing, China
| | - Zongchen Zhao
- Department of Clinical Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Panxiang Cao
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Li Li
- Department of Clinical Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoli Ma
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Lili Yuan
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Fang Wang
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Yang Zhang
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Jiaqi Chen
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Jiancheng Fang
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Ming Liu
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Mingyue Liu
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xue Chen
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Hongxing Liu
- Beijing Lu Daopei Institute of Hematology, Beijing, China
- Division of Pathology & Laboratory Medicine, Hebei Yanda Lu Daopei Hospital, Langfang, China
| |
Collapse
|
15
|
Kirkham JK, Liu YC, Foy SG, Ma J, Gheorghe G, Furtado LV, Popescu MI, Klco JM, Karol SE, Blackburn PR. Clinical and genomic characterization of an ATRA-insensitive acute promyelocytic leukemia variant with a FNDC3B::RARB fusion. Genes Chromosomes Cancer 2023; 62:617-623. [PMID: 37283355 DOI: 10.1002/gcc.23180] [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: 04/06/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
The promyelocytic leukemia-retinoic acid receptor-α (PML::RARA) fusion is the hallmark of acute promyelocytic leukemia (APL) and is observed in over 95% of APL cases. RARA and homologous receptors RARB and RARG are occasionally fused to other gene partners, which differentially affect sensitivity to targeted therapies. Most APLs without RARA fusions have rearrangements involving RARG or RARB, both of which frequently show resistance to all-trans-retinoic acid (ATRA) and/or multiagent chemotherapy for acute myeloid leukemia (AML). We present a 13-year-old male diagnosed with variant APL with a novel FNDC3B::RARB in-frame fusion that showed no response to ATRA but responded well to conventional AML therapy. While FNDC3B has been identified as a rare RARA translocation partner in ATRA-sensitive variant APL, it has never been reported as a fusion partner with RARB and it is only the second known fusion partner with RARB in variant APL. We also show that this novel fusion confers an RNA expression signature that is similar to APL, despite clinical resistance to ATRA monotherapy.
Collapse
MESH Headings
- Male
- Humans
- Adolescent
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Translocation, Genetic
- Tretinoin/therapeutic use
- Leukemia, Myeloid, Acute/genetics
- Retinoic Acid Receptor alpha/genetics
- Genomics
- Oncogene Proteins, Fusion/genetics
- Fibronectins/genetics
Collapse
Affiliation(s)
- Justin K Kirkham
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yen-Chun Liu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Scott G Foy
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gabriela Gheorghe
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Larissa V Furtado
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Marcela I Popescu
- Department of Pediatric Hematology and Oncology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Jeffery M Klco
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Seth E Karol
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Patrick R Blackburn
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
16
|
Borkovskaia A, Bogacheva S, Konyukhova T, Dadakhanova E, Gaskova M, Soldatkina O, Dubrovina M, Popov A, Mikhailova E, Inushkina E, Kazanov M, Matveev E, Novichkova G, Maschan M, Maschan A, Olshanskaya Y, Zerkalenkova E. Molecular Heterogeneity of Pediatric AML with Atypical Promyelocytes Accumulation in Children—A Single Center Experience. Genes (Basel) 2023; 14:genes14030675. [PMID: 36980947 PMCID: PMC10048084 DOI: 10.3390/genes14030675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Acute promyelocytic leukemia (APL) pathogenesis is based on RARA gene translocations, which are of high importance in the diagnosis of and proper therapy selection for APL. However, in some cases acute myeloid leukemia (AML) demonstrates APL-like morphological features such as atypical promyelocytes accumulation. This type of AML is characterized by the involvement of other RAR family members or completely different genes. In the present study, we used conventional karyotyping, FISH and high-throughput sequencing in a group of 271 de novo AML with atypical promyelocytes accumulation. Of those, 255 cases were shown to carry a typical chromosomal translocation t(15;17)(q24;q21) with PML::RARA chimeric gene formation (94.1%). Other RARA-positive cases exhibited cryptic PML::RARA fusion without t(15;17)(q24;q21) (1.8%, n = 5) and variant t(5;17)(q35;q21) translocation with NPM1::RARA chimeric gene formation (1.5%, n = 4). However, 7 RARA-negative AMLs with atypical promyelocytes accumulation were also discovered. These cases exhibited TBL1XR1::RARB and KMT2A::SEPT6 fusions as well as mutations, e.g., NPM1 insertion and non-recurrent chromosomal aberrations. Our findings demonstrate the genetic diversity of AML with APL-like morphological features, which is of high importance for successful therapy implementation.
Collapse
Affiliation(s)
- Aleksandra Borkovskaia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Sofia Bogacheva
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Tatiana Konyukhova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Elina Dadakhanova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Marina Gaskova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Olga Soldatkina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Maria Dubrovina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Alexander Popov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Ekaterina Mikhailova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Evgenia Inushkina
- Moscow Regional Oncology Hospital, Karbisheva Str. 6, 143900 Balashikha, Russia
| | - Marat Kazanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
- Institute for Information Transmission Problems (the Kharkevich Institute, RAS), Bolshoy Karetny per. 19, bld. 1, 127051 Moscow, Russia
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard 30, bld. 1, 121205 Moscow, Russia
| | - Evgeniy Matveev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
- Institute for Information Transmission Problems (the Kharkevich Institute, RAS), Bolshoy Karetny per. 19, bld. 1, 127051 Moscow, Russia
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard 30, bld. 1, 121205 Moscow, Russia
| | - Galina Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Michael Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Alexey Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Yulia Olshanskaya
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Elena Zerkalenkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
- Correspondence:
| |
Collapse
|
17
|
Liu G, Long J, Chen Y, Li L, Huan X, Long P. Acute promyelocytic leukemia with FIP1L1::RARA fusion gene: The clinical utility of transcriptome sequencing and bioinformatic analyses. Front Oncol 2023; 12:1049473. [PMID: 36776354 PMCID: PMC9910307 DOI: 10.3389/fonc.2022.1049473] [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: 09/20/2022] [Accepted: 12/29/2022] [Indexed: 01/27/2023] Open
Abstract
Background Acute promyelocytic leukemia (APL) is typically characterized by the presence of coagulopathy and the PML::RARA fusion gene. The FIP1L1::RARA has been reported as a novel fusion gene, but studies on its pathogenesis are limited. Objectives A FIP1L1::RARA fusion in a child finally diagnosed as APL was reported. RNA sequencing (RNA-seq) of six patients (three cases of acute lymphoblastic leukemia (ALL), one case of myelodysplastic syndrome (MDS), one case of acute megakaryoblastic leukemia (M7), and one case of APL with FIP1L1::RARA) were performed. Methods Transcriptome analysis of six patients was performed by RNA-seq. The heat map was used for showing the RNA expression profile, the volcano plot for identifying differential expression genes (DEGs), and the KEGG Orthology-Based Annotation System (KOBAS) online biological information database for KEGG pathway enrichment analysis. Results Obvious differences between APL with FIP1L1::RARA and hematologic malignancies were identified. 1060 common differentially expressed genes (co-DEGs) were detected between APL with FIP1L1::RARA vs ALL and APL with FIP1L1::RARA vs myeloid neoplasms (MDS, M7), the up-regulated genes were mainly mapped into platelet activation, cancer, AMPK signaling pathway, PI3K-Akt signaling pathway, and MAPK signaling pathway. The down-regulated genes were significantly associated with TNF signaling pathway, Rap1 signaling pathway, Age-RAGE signaling pathway, and apoptosis. Conclusion A FIP1L1::RARA fusion in a child finally diagnosed as APL was reported. RNA-seq may provide a new diagnostic method when RARA rearrangements fail to be identified by conventional methods. In the analysis of co-DEGs between case vs ALL and case vs myeloid neoplasms, the up-regulated and down-regulated genes were enriched in different signaling pathways. Further experimental studies are needed to identify pathogenesis and treatment for APL with FIP1L1::RARA.
Collapse
Affiliation(s)
- Guanghua Liu
- Laboratory of Hematology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China,Department of Blood Transfusion, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jiangwen Long
- Laboratory of Hematology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China,Department of Blood Transfusion, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yuyu Chen
- Hunan Cancer Hospital (the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University), Clinical Laboratory, Changsha, China
| | - Lingqian Li
- Laboratory of Hematology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China,Department of Blood Transfusion, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xisha Huan
- Laboratory of Hematology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China,Department of Blood Transfusion, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Panpan Long
- Genetic Center, Changsha Jiangwan Maternity Hospital, Changsha, China,*Correspondence: Panpan Long,
| |
Collapse
|
18
|
Iyer SG, Elias L, Stanchina M, Watts J. The treatment of acute promyelocytic leukemia in 2023: Paradigm, advances, and future directions. Front Oncol 2023; 12:1062524. [PMID: 36741714 PMCID: PMC9889825 DOI: 10.3389/fonc.2022.1062524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
The transformation of acute promyelocytic leukemia (APL) from an often fatal to highly curable cancer with long-term survival exceeding 90% is one of the greatest and most inspiring successes in oncology. A deeper understanding of the pathogenesis of APL heralded the introduction of highly effective therapies targeting the mutant protein that drives the disease, leading to the chemotherapy-free approach to cure almost all patients. In this review, we discuss the paradigm of treatment of APL in 2023, reinforce the high risk of early death without prompt initiation of treatment at first clinical suspicion, and dedicate a special focus to novel agents and future directions to improve cure rates and quality of life in patients affected by APL.
Collapse
Affiliation(s)
- Sunil Girish Iyer
- Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laila Elias
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michele Stanchina
- Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Justin Watts
- Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
19
|
Chen L, Zhu H, Zhu Y, Jin W, Dong F, Li J, Hu J, Chen Q, Wang K, Li J. Case Report: Successful therapy with all-trans retinoic acid combined with chemotherapy followed by hematopoietic stem cell transplantation for acute promyelocytic leukemia carrying the BCOR-RARA fusion gene. Front Oncol 2022; 12:1013046. [PMID: 36212492 PMCID: PMC9539026 DOI: 10.3389/fonc.2022.1013046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is characterized by the balanced translocation of chromosomes 15 and 17, resulting in the formation of PML-RARA fusion gene. More than 98% of APL have PML-RARA fusion, and less than 2% have other types of RARA gene partners, which named variant APL (vAPL). In the present study, we reported a vAPL with BCOR-RARA, which was the third case of BCOR-RARA APL published. The patient achieved complete remission (CR) with all-trans retinoic acid (ATRA) monotherapy, and molecular CR with ATRA plus standard chemotherapy. After that, he underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and ATRA maintenance and maintained a molecular CR status. This case provided valuable insights into the accurate identification of vAPL. Moreover, ATRA combined with chemotherapy followed by allo-HSCT was suggested as an optimal choice for those vAPL patients who had a high risk of relapse.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Junmin Li
- *Correspondence: Junmin Li, ; Kankan Wang,
| |
Collapse
|