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Zanelli M, Bisagni A, Sanguedolce F, Broggi G, Fragliasso V, Zizzo M, Palicelli A, Martino G, Cresta C, Caprera C, Corsi M, Gentile P, Gozzi F, Trombetta D, Parente P, Caltabiano R, Koufopoulos N, Cimino L, Cavazza A, Fraternali Orcioni G, Ascani S. Co-occurrence of JAK2-V617 F mutation and BCR::ABL1 translocation in chronic myeloproliferative neoplasms: a potentially confounding genetic combination. Front Oncol 2024; 13:1329298. [PMID: 38282677 PMCID: PMC10811046 DOI: 10.3389/fonc.2023.1329298] [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: 10/28/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
Myeloproliferative neoplasms (MPNs) are classified into Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) and Ph-negative MPNs. BCR::ABL1 translocation is the key genetic event of CML, whereas JAK2/MPL/CALR mutations are molecular aberrations of Ph-negative MPNs. Despite initially considered mutually exclusive genetic aberrations, the co-occurrence of BCR::ABL1 and JAK2 has been reported in a limited number of cases. The two genetic alterations may be identified either at the same time or JAK2 aberration may be detected in patients with a previous CML treated with tyrosine kinase inhibitors or, finally, BCR::ABL1 translocation occurs in patients with a history of JAK2-positive MPN. This combination of genomic alterations is potentially confounding with clinical manifestations often misinterpreted either as disease progression or drug resistance, therefore leading to inappropriate patient's treatment. Our systematic review aims to improve hematologist and pathologist knowledge on this rare subset of patients. Starting from the presentation of two additional cases from our routine daily practice, we focus mainly on clinical, laboratory, and bone marrow histological findings, which may represent useful clues of BCR::ABL1 and JAK2 co-occurrence. The interaction between JAK2 and BCR::ABL1 clones during the disease course as well as therapy and outcome are presented.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emila, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
- Hematology, Centro di Ricerca Emato-Oncologica (C.R.E.O.), University of Perugia, Perugia, Italy
| | - Camilla Cresta
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Pietro Gentile
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Trombetta
- Laboratory Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Paola Parente
- Laboratory Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
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Aktekin EH, Yazici N, Kozanoğlu İ, Erbay A. Is very high platelet count always associated with essential thrombocythemia? An unusual presentation in a child. Lab Med 2023; 54:e170-e176. [PMID: 37352366 DOI: 10.1093/labmed/lmad053] [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] [Indexed: 06/25/2023] Open
Abstract
Myeloproliferative neoplasms are rare in childhood. They are categorized as Philadelphia chromosome-positive and Philadelphia chromosome-negative. Chronic myeloid leukemia (CML) is the most common myeloproliferative disease in which the Philadelphia chromosome is detected as a result of BCR-ABL rearrangements. In others, the most common genetic abnormality is JAK2V617F mutation. The coexistence of these 2 abnormalities in CML is unexpected, and rare cases have recently been reported in adults. We present a child who had a very high platelet count in which we found this coexistence. The clinical presentation, laboratory findings, management, and prognosis of this coexistence is challenging in such a rare condition.
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Affiliation(s)
- Elif Habibe Aktekin
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
| | - Nalan Yazici
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
| | - İlknur Kozanoğlu
- Department of Physiology and the Apheresis Unit Adult Bone Marrow Transplant Centre, Baskent University, Adana, Turkey
| | - Ayşe Erbay
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
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Tirrò E, Stella S, Massimino M, Zammit V, Pennisi MS, Vitale SR, Romano C, Di Gregorio S, Puma A, Di Raimondo F, Stagno F, Manzella L. Colony-Forming Cell Assay Detecting the Co-Expression of JAK2V617F and BCR-ABL1 in the Same Clone: A Case Report. Acta Haematol 2019; 141:261-267. [PMID: 30965317 DOI: 10.1159/000496821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/11/2019] [Indexed: 01/14/2023]
Abstract
BCR-ABL1-negative myeloproliferative disorders and chronic myeloid leukaemia are haematologic malignancies characterised by single and mutually exclusive genetic alterations. Nevertheless, several patients co-expressing the JAK2V617F mutation and the BCR-ABL1 transcript have been described in the literature. We report the case of a 61-year-old male who presented with an essential thrombocythaemia phenotype and had a subsequent diagnosis of chronic phase chronic myeloid leukaemia. Colony-forming assays demonstrated the coexistence of 2 different haematopoietic clones: one was positive for the JAK2V617F mutation and the other co-expressed both JAK2V617F and the BCR-ABL1 fusion gene. No colonies displayed the BCR-ABL1 transcript alone. These findings indicate that the JAK2V617F mutation was the founding genetic alteration of the disease, followed by the acquisition of the BCR-ABL1 chimeric oncogene. Our data support the hypothesis that a heterozygous JAK2V617F clone may have favoured the bi-clonal nature of this myeloproliferative disorder, generating clones harbouring a second transforming genetic event.
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MESH Headings
- Amino Acid Substitution
- Colony-Forming Units Assay
- Fusion Proteins, bcr-abl/biosynthesis
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Enzymologic
- Gene Expression Regulation, Leukemic
- Humans
- Janus Kinase 2/biosynthesis
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Mutation, Missense
- Thrombocythemia, Essential/enzymology
- Thrombocythemia, Essential/genetics
- Thrombocythemia, Essential/pathology
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Affiliation(s)
- Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy,
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy,
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Valentina Zammit
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Sandra Di Gregorio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
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Schelker RC, Andrulis M, Müller G, Ushmorov A, Hart C, Herr W, Vogelhuber M, Iberl S, Grassinger J. Dasatinib reduces myelofibrosis by modulating pSTAT5 and NF-κB. Blood Cells Mol Dis 2019; 76:78-81. [PMID: 30827761 DOI: 10.1016/j.bcmd.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Roland Christian Schelker
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Mindaugas Andrulis
- Department of Pathology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Gunnar Müller
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Alexey Ushmorov
- Institute of Physiological Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Christina Hart
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Sabine Iberl
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Jochen Grassinger
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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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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6
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Myeloproliferative neoplasms with concurrent BCR-ABL1 translocation and JAK2 V617F mutation: a multi-institutional study from the bone marrow pathology group. Mod Pathol 2018; 31:690-704. [PMID: 29327708 PMCID: PMC6008160 DOI: 10.1038/modpathol.2017.182] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 11/08/2022]
Abstract
Myeloproliferative neoplasms arise from hematopoietic stem cells with somatically altered tyrosine kinase signaling. Classification of myeloproliferative neoplasms is based on hematologic, histopathologic and molecular characteristics including the presence of the BCR-ABL1 and JAK2 V617F. Although thought to be mutually exclusive, a number of cases with co-occurring BCR-ABL1 and JAK2 V617F have been identified. To characterize the clinicopathologic features of myeloproliferative neoplasms with concomitant BCR-ABL1 and JAK2 V617F, and define the frequency of co-occurrence, we conducted a retrospective multi-institutional study. Cases were identified using a search of electronic databases over a decade at six major institutions. Of 1570 patients who were tested for both BCR-ABL1 and JAK2 V617F, six were positive for both. An additional five patients were identified via clinical records providing a total of 11 cases for detailed evaluation. For each case, clinical variables, hematologic and genetic data, and bone marrow histomorphologic features were analyzed. The sequence of identification of the genetic abnormalities varied: five patients were initially diagnosed with a JAK2 V617F+ myeloproliferative neoplasm, one patient initially had BCR-ABL1+ chronic myeloid leukemia, while both alterations were identified simultaneously in five patients. Classification of the BCR-ABL1-negative myeloproliferative neoplasms varied, and in some cases, features only became apparent following tyrosine kinase inhibitor therapy. Seven of the 11 patients showed myelofibrosis, in some cases before identification of the second genetic alteration. Our data, reflecting the largest reported study comprehensively detailing clinicopathologic features and response to therapy, show that the co-occurrence of BCR-ABL1 and JAK2 V617F is rare, with an estimated frequency of 0.4%, and most often reflects two distinct ('composite') myeloproliferative neoplasms. Although uncommon, it is important to be aware of this potentially confounding genetic combination, lest these features be misinterpreted to reflect resistance to therapy or disease progression, considerations that could lead to inappropriate management.
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Schelker RC, Huber E, Herr W, Vogelhuber M. Marked regression of myelofibrosis during reduced-dose dasatinib treatment in chronic myelogenous leukemia in accelerated phase. Leuk Lymphoma 2015; 57:219-22. [PMID: 26110883 DOI: 10.3109/10428194.2015.1045899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Roland Christian Schelker
- a Department of Internal Medicine III , Hematology & Oncology, University Hospital of Regensburg , Regensburg , Germany
| | - Elisabeth Huber
- b Department of Pathology , University Hospital of Regensburg , Regensburg , Germany
| | - Wolfgang Herr
- a Department of Internal Medicine III , Hematology & Oncology, University Hospital of Regensburg , Regensburg , Germany
| | - Martin Vogelhuber
- a Department of Internal Medicine III , Hematology & Oncology, University Hospital of Regensburg , Regensburg , Germany
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8
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Qin YW, Yang YN, Li S, Wang C. Coexistence of JAK2V617F Mutation and BCR-ABL Translocation in a Pregnant Woman with Essential Thrombocythemia. Indian J Hematol Blood Transfus 2014; 30:331-4. [PMID: 25332611 DOI: 10.1007/s12288-014-0385-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/30/2014] [Indexed: 02/05/2023] Open
Abstract
In 2012, a 25-years-old pregnant woman presented with thromocytosis for 4 months, blood counts showed platelets 701 × 10(9)/L. Bone marrow examination disclosed a feature of hypercellular marrow in erythrocytic,granulocytic and megakaryocytic series. Cytogenetic analysis showed t(9;22)(q34;q11) in 100 % of metaphase. The percentage of BCR-ABL-positive FISH signals was 37 % in the peripheral blood. Molecular analysis showed the presence of the JAK2V617F mutation and BCR-ABL mRNA b3a2 transcript. A diagnosis of concomitant presence of essential thrombocythemia and chronic myelocytic leukemia was made. Based on this case and literatures reported before, it might be necessary to detect JAK2-V617F mutation and BCR-ABL fusion gene concomitantly in myeloproliferative neoplasms patients.
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Affiliation(s)
- You-Wen Qin
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Yi-Ning Yang
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Su Li
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Chun Wang
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
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Xu W, Chen B, Tong X. Chronic myeloid leukemia patient with co-occurrence of BCR-ABL junction and JAK2 V617F mutation. Int J Hematol 2013; 99:87-90. [PMID: 24293258 DOI: 10.1007/s12185-013-1480-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 01/11/2023]
Abstract
The JAK2 V617F mutation is common in patients with Philadelphia-negative chronic myeloproliferative neoplasms, but few cases of the JAK2 V617F mutation have been described in Philadelphia-positive chronic myeloid leukemia (CML) patients. Here, we report a 21-year-old female who presented with phenotype of CML in whom BCR-ABL transcript and JAK2V617F mutation co-occurred. These findings were determined through cytogenetic analysis, fluorescence in situ hybridization, and allele-specific (AS) PCR. The patient's BCR-ABL transcript disappeared after 6 months of treatment with imatinib, while the JAK2V617F mutation remained positive. We discuss this case with reference to the current literature.
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Affiliation(s)
- Weiyi Xu
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China,
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