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Yamamoto K, Kitao A, Watanabe M, Kanehira H, Joyce M, Hirakawa Y, Matsumoto S, Yakushijin K, Minami H. RUNX1 rearrangement in mature B-cell acute lymphoblastic leukemia with non-L3 morphology. J Clin Exp Hematop 2023; 63:240-245. [PMID: 37899239 PMCID: PMC10861373 DOI: 10.3960/jslrt.23028] [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: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/31/2023] Open
Abstract
Mature B-cell acute lymphoblastic leukemia (ALL) is defined by the expression of light chain-restricted surface immunoglobulin (sIg) and usually has features of the leukemic phase of Burkitt lymphoma including FAB-L3 morphology and MYC rearrangement. Recently, another distinct entity in childhood mature B-cell ALL has been characterized as non-L3 morphology and KMT2A rearrangement. Here we report an unusual case of mature B-cell ALL that presented with RUNX1 rearrangement. A 65-year-old male was admitted to our department for thorough examination of leukocytosis and thrombocytopenia. The patient's bone marrow was hypercellular and infiltrated with 97.8% myeloperoxidase-negative, medium-to-large-sized blasts without cytoplasmic vacuoles. Immunophenotypes were characterized by the presence of light chain-restricted sIg and the lack of immature markers, indicating a diagnosis of mature B-cell ALL with L2 morphology: sIg-κ+, CD19+, CD20+, CD22+, CD79a+, TdT-, and CD34-. G-banding combined with spectral karyotyping showed the following complex karyotype: 45,X,der(Y;10)(p10;q10),del(13)(q?),inv(21)(p13q22.1). Fluorescence in situ hybridization revealed separated signals of RUNX1 at 21q22.1, whereas rearrangements of MYC and KMT2A were not found. To our knowledge, inv(21)(p13q22.1) involving RUNX1 is a novel cytogenetic aberration and this is the first case of mature B-cell ALL that presented with RUNX1 rearrangement. Thus, RUNX1 may be implicated in the pathogenesis of mature B-cell ALL showing non-L3 morphology without MYC rearrangement.
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Affiliation(s)
- Katsuya Yamamoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akihito Kitao
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Marika Watanabe
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kanehira
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Miki Joyce
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuri Hirakawa
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sakuya Matsumoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Yakushijin
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Cui Y, Zhou M, Zou P, Liao X, Xiao J. Mature B cell acute lymphoblastic leukaemia with KMT2A-MLLT3 transcripts in children: three case reports and literature reviews. Orphanet J Rare Dis 2021; 16:331. [PMID: 34330316 PMCID: PMC8325316 DOI: 10.1186/s13023-021-01972-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mature B cell acute lymphoblastic leukaemia (BAL) is characterised by French-American-British (FAB)-L3 morphology and the presence of surface immunoglobulin (sIgM) light chain restriction. BAL is also considered as the leukaemic phase of Burkitt lymphoma (BL), in which t (8; 14) (q24; q32) or its variants are related to the myelocytomatosis oncogene (MYC) rearrangement (MYCr) is usually present. However, BAL with lysine methyltransferase 2A (KMT2A, previously called Mixed lineage leukaemia, MLL) gene rearrangement (KMT2Ar, previously called MLLr) is rare. RESULTS Three BAL patients with KMT2Ar were enrolled between January 2017 and November 2019, accounting for 1.37% of the B-ALL population in our hospital. We also reviewed 24 previously reported cases of BAL and KMT2Ar and analysed the features, treatment, and prognosis. Total 13 males and 14 females were enrolled in our research, and the average age at diagnosis was 19.5 ± 4.95 months old. In these 27 patients, renal, central nervous system (CNS) and skin involvement were existent in 6, 4 and 3 patients, respectively; 26 patients (26/27) showed non-ALL-L3 morphology, while one patient is ALL-L3; overexpression of CD19 was detected in most cases, negative or suspicious expression of CD20 was found in 64% of patients. KMT2Ar was reported, but MYCr was not observed. 25 patients (25/27) achieved complete remission after chemotherapy or Stem cell transplantation. The patients were sensitive to chemotherapy, prospective event-free survival (pEFS) of BAL patients with KMT2Ar who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) was higher than that in patients who received chemotherapy alone (83.33% vs 41.91%). CONCLUSION BAL patients with KMT2Ar had unique manifestations, including younger age at diagnosis and overexpression of CD19; expression of CD20 was rare, and MYCr was undetectable. The pEFS was higher in patients undergoing allo-HSCT than in patients undergoing chemotherapy alone.
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Affiliation(s)
- Yinghui Cui
- Division of Haematology and Oncology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China
- National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Paediatrics, Chongqing, People's Republic of China
| | - Min Zhou
- Department of Hematology, Chengdu Women's & Children's Central Hospital, Chengdu, People's Republic of China
| | - Pinli Zou
- Division of Haematology and Oncology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People's Republic of China
- National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China
| | - Xin Liao
- Division of Haematology and Oncology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Paediatrics, Chongqing, People's Republic of China
| | - Jianwen Xiao
- Division of Haematology and Oncology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People's Republic of China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China.
- Chongqing Key Laboratory of Paediatrics, Chongqing, People's Republic of China.
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3
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Hidalgo-Gómez G, Palacio-Garcia C, Gallur L, Blanco A, Tazón-Vega B, Saumell S, Martínez N, Murillo L, Murciano T, Velasco P, Bosch F, Diaz-Heredia C, Ortega M. Is acute lymphoblastic leukemia with mature B-cell phenotype and KMT2A rearrangements a new entity? A systematic review and meta-analysis. Leuk Lymphoma 2021; 62:2202-2210. [PMID: 33827367 DOI: 10.1080/10428194.2021.1907375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The association between mature B-cell phenotype and KMT2A rearrangements in acute lymphoblastic leukemia is a very rare finding. It identifies a group of patients with similar clinical and biological characteristics that clearly differs from the entity B-cell lymphoblastic leukemia/lymphoma with t(v;11q23)/KMT2A-rearranged, which typically presents an immature pro B-cell phenotype. We describe the clinical-biological characteristics and disease outcome of three pediatric ALL patients with these features treated at our institution, and review 28 cases described in the literature. Most cases occur in children under 2 years-old, presenting a mature B-cell phenotype that uniformly expresses cytoplasmic and surface IgM with lambda light chain restriction, with heterogeneous co-expression of immaturity antigens. Patients do not have MYC rearrangements and all show KMT2A abnormalities, with 76% presenting t(9;11)(p21;q23)/MLLT3-KMT2A. These patients have an unfavorable clinical outcome and a 48% relapse rate. In-depth knowledge of this disease entity is needed to improve outcome.
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Affiliation(s)
- Gloria Hidalgo-Gómez
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Carlos Palacio-Garcia
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Laura Gallur
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Adoración Blanco
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Bárbara Tazón-Vega
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Silvia Saumell
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Noemí Martínez
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Laura Murillo
- Pediatric Oncology and Hematology Service, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Thais Murciano
- Pediatric Oncology and Hematology Service, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Velasco
- Pediatric Oncology and Hematology Service, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Bosch
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Diaz-Heredia
- Pediatric Oncology and Hematology Service, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Margarita Ortega
- Hematology Service, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Burkitt Leukemia With Precursor B-Cell Immunophenotype and Dual Translocation of t(14;18) and t(8;14) in a Child: Case Report and Review of the Literature. J Pediatr Hematol Oncol 2020; 42:e61-e63. [PMID: 30499905 DOI: 10.1097/mph.0000000000001354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burkitt leukemia (BL) with the precursor B-cell immunophenotype is a rarely reported condition. The prognosis of such patients is similar to that of classic BL. However, the combination of chromosomal translocations associated with bcl-2 and c-myc rearrangement has a poor prognosis. OBSERVATIONS An 11-year-old child presented with fever and weakness. Bone marrow aspiration showed morphologically L1 type blasts and flow cytometry analysis was compatible with precursor B-cell immunophenotype. Cytogenetic analysis revealed a combination of t(8;14) and t(14;l8). CONCLUSIONS The combination of t(8;14) and t(14;l8) can exhibit different immunophenotypical and morphologic features in leukemias.
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5
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Heterogeneity of childhood acute leukemia with mature B-cell immunophenotype. J Cancer Res Clin Oncol 2019; 145:2803-2811. [PMID: 31463716 DOI: 10.1007/s00432-019-03010-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Flow cytometry (FCM) plays a crucial role in the differential diagnosis of Burkitt lymphoma/leukemia (BL) and B-cell precursor acute lymphoblastic leukemia (BCP-ALL). The presence of surface IgM (sIgM) alone or with light chain restriction indicates a mature blast phenotype (BIV by EGIL) and is usually observed in BL. However, sIgM expression could also be detected in transitional BCP-ALL cases. These similarities in immunophenotype and ambiguous correspondence with other laboratory findings may challenge the correct BL diagnostics. METHODS We retrospectively reviewed the available data from immunophenotypic, morphological, cytogenetic, and molecular genetic studies of 146 children (85 boys and 61 girls) with a median age of 10 years (range 0-18 years) who were diagnosed with BL and BCP-ALL. The blasts' immunophenotype was studied by multicolor FCM. The conventional cytogenetic analysis included G-banded karyotyping and fluorescence in situ hybridization (FISH). RESULTS In 54 children classified as BIV-ALL according to the EGIL, it was demonstrated that sIgM in a minority of cases can be associated with various types of BCP-ALL. Analysis of the antigen expression profile of 105 patients with verified BL (n = 21) and BCP-ALL (n = 84) showed significant differences in BL and the sIgM(+) vs BCP-ALL immunophenotype. Thus, even in cases of ambiguous sIgM expression, these two diseases could be reliably discriminated by complex immunophenotyping. Moreover, 10 patients (7 boys and 3 girls) with BL leukemic cells did not express sIgM, and they were diagnosed with BL on the basis of other laboratory and clinical signs. CONCLUSIONS In conclusion, our study shows that BIV subtype is heterogeneous group of leukemia including not only the BL, but also BCP-ALL. In ambiguous cases, only a combination of multiple immunophenotypic, cytomorphologic, and genetic diagnostic technologies can allow the precise discrimination of BL and BCP-ALL and selection of the appropriate treatment scheme.
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6
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Wang YM, Mo JQ, Kuo DJ, Wong V. MLL rearranged acute lymphoblastic leukaemia presenting as a maxillary sinus mass with a discordant immunophenotypic profile from the bone marrow. BMJ Case Rep 2019; 12:12/2/e227400. [PMID: 30772833 DOI: 10.1136/bcr-2018-227400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe an unusual case of pre-B lymphoblastic leukaemia presenting with a unilateral maxillary sinus mass in which biopsies of the primary mass and the bone marrow demonstrated conflicting immunophenotyping results. The extramedullary mass was consistent with a precursor B-cell malignancy, while the bone marrow was initially reported as a possible mature B-cell malignancy. The treatments for the two are fundamentally different, which necessitated a delay in the initiation of his chemotherapy until a clear diagnosis was made. Mixed lineage leukaemia gene rearrangement was confirmed by fluorescence in situ hybridisation in both the primary mass and bone marrow, which unified the diagnosis as pre-B acute lymphoblastic leukaemia given the common cytogenetic feature.
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Affiliation(s)
- Yunzu Michele Wang
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California, USA
| | - Jun Qin Mo
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Dennis John Kuo
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California, USA
| | - Victor Wong
- Department of Pediatric Hematology-Oncology, University of California San Diego, San Diego, California, USA
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7
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Yao QH, Liu YF, Fang YQ, Zhao XM. [Childhood B-cell acute lymphoblastic leukemia of nonL3 morphology with mature phenotype and MLL-AF9 gene fusion: a case report and literatures review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:947-949. [PMID: 30486594 PMCID: PMC7342363 DOI: 10.3760/cma.j.issn.0253-2727.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Y F Liu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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8
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Single-cell screening of multiple biophysical properties in leukemia diagnosis from peripheral blood by pure light scattering. Sci Rep 2017; 7:12666. [PMID: 28979002 PMCID: PMC5627307 DOI: 10.1038/s41598-017-12990-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/18/2017] [Indexed: 12/31/2022] Open
Abstract
Histology and histopathology are based on the morphometric observations of quiescent cells. Their diagnostic potential could largely benefit from a simultaneous screening of intrinsic biophysical properties at single-cell level. For such a purpose, we analyzed light scattering signatures of individual mononuclear blood cells in microfluidic flow. In particular, we extracted a set of biophysical properties including morphometric (dimension, shape and nucleus-to-cytosol ratio) and optical (optical density) ones to clearly discriminate different cell types and stages. By considering distinctive ranges of biophysical properties along with the obtained relative cell frequencies, we can identify unique cell classes corresponding to specific clinical conditions (p < 0.01). Based on such a straightforward approach, we are able to discriminate T-, B-lymphocytes, monocytes and beyond that first results on different stages of lymphoid and myeloid leukemia cells are presented. This work shows that the simultaneous screening of only three biophysical properties enables a clear distinction between pathological and physiological mononuclear blood stream cells. We believe our approach could represent a useful tool for a label-free analysis of biophysical single-cell signatures.
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9
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Dworzak MN, Buldini B, Gaipa G, Ratei R, Hrusak O, Luria D, Rosenthal E, Bourquin JP, Sartor M, Schumich A, Karawajew L, Mejstrikova E, Maglia O, Mann G, Ludwig WD, Biondi A, Schrappe M, Basso G. AIEOP-BFM Consensus Guidelines 2016 for Flow Cytometric Immunophenotyping of Pediatric Acute Lymphoblastic Leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:82-93. [DOI: 10.1002/cyto.b.21518] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/16/2017] [Accepted: 02/06/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Michael N. Dworzak
- Children's Cancer Research Institute and St. Anna Children's Hospital, Department of Pediatrics; Medical University of Vienna; Vienna Austria
| | - Barbara Buldini
- Laboratory of Pediatric Onco-Hematology, Women and Child Department; University of Padova; Padova Italy
| | - Giuseppe Gaipa
- Tettamanti Research Center and Department of Pediatrics; Ospedale San Gerardo, University of Milano-Bicocca; Monza Italy
| | - Richard Ratei
- Clinic for Oncology and Tumor Immunology; HELIOS Klinikum Berlin-Buch; Berlin Germany
| | - Ondrej Hrusak
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine; Charles University and University Hospital Motol; Prague Czech Republic
| | - Drorit Luria
- Department of Pediatric Hematology and Oncology; Schneider's Children's Medical Center; Petach-Tikva Israel
| | - Eti Rosenthal
- Cancer Research Center and the Hematology Laboratory, Jeffrey Modell Foundation (JMF) Center, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
| | - Jean-Pierre Bourquin
- Division of Oncology and Children's Research Center; University Children's Hospital, University of Zurich; Zurich Switzerland
| | - Mary Sartor
- Flow Cytometry Unit; Institute of Clinical Pathology and Medical Research, Westmead Hospital; Sydney Australia
| | - Angela Schumich
- Children's Cancer Research Institute and St. Anna Children's Hospital, Department of Pediatrics; Medical University of Vienna; Vienna Austria
| | - Leonid Karawajew
- Department of Pediatric Oncology/Hematology; Charité Universitätsmedizin; Berlin Germany
| | - Ester Mejstrikova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine; Charles University and University Hospital Motol; Prague Czech Republic
| | - Oscar Maglia
- Tettamanti Research Center and Department of Pediatrics; Ospedale San Gerardo, University of Milano-Bicocca; Monza Italy
| | - Georg Mann
- Children's Cancer Research Institute and St. Anna Children's Hospital, Department of Pediatrics; Medical University of Vienna; Vienna Austria
| | - Wolf-Dieter Ludwig
- Clinic for Oncology and Tumor Immunology; HELIOS Klinikum Berlin-Buch; Berlin Germany
| | - Andrea Biondi
- Tettamanti Research Center and Department of Pediatrics; Ospedale San Gerardo, University of Milano-Bicocca; Monza Italy
| | - Martin Schrappe
- Department of Pediatrics; University Medical Center Schleswig-Holstein; Kiel Germany
| | - Giuseppe Basso
- Laboratory of Pediatric Onco-Hematology, Women and Child Department; University of Padova; Padova Italy
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10
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Dong Y, Liu F, Wu C, Li S, Zhao X, Zhang P, Jiao J, Yu X, Ji Y, Zhang M. Illegitimate RAG-mediated recombination events are involved in IKZF1 Δ3-6 deletion in BCR-ABL1 lymphoblastic leukaemia. Clin Exp Immunol 2016; 185:320-31. [PMID: 27198500 DOI: 10.1111/cei.12812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/29/2022] Open
Abstract
Breakpoint cluster region-Abelson murine leukaemia viral oncogene homologue 1 (BCR-ABL1), encoded by the Philadelphia (Ph) chromosome, is the characteristic of chronic myeloid leukaemia (CML) and a subset of acute lymphoblastic leukaemia (ALL). We demonstrated that expression of the Ik6 transcript, which lacked exons 3-6, was observed exclusively in BCR-ABL1(+) B ALL and lymphoid blast crisis CML (BC-CML) patients harbouring the IKZF1 Δ3-6 deletion. To confirm the hypothesis that illegitimate recombination activating gene protein (RAG)-mediated recombination events are involved in IKZF1 Δ3-6 deletion in BCR-ABL1 lymphoblastic leukaemia, we first demonstrated that the expression rates of RAG1 and RAG2, collectively called RAG, were higher in ALL and BC-CML (lymphoid). Notably, analysis of relationships among RAG, BCR-ABL1 and Ikaros 6 (Ik6) showed that Ik6 can be generated only if RAG and BCR-ABL1 are co-existing. The sequencing data showed that the deleted segments of introns 2 and 6 contained cryptic recombination signal sequences (cRSSs) and frequently had non-template nucleotides inserted between breakpoints. Furthermore, we used chromatin immunoprecipitation (ChIP) technology and demonstrated that the sequences directly flanking IKZF1 Δ3-6 deletion breakpoints have significantly higher levels of histone H3 lysine 4 trimethylation (H3K4me3) modifications. Overall, RAG expression, good-quality cRSS and a specific chromatin modification, H3K4me3, satisfy the conditions of RAG's off-target effects on IKZF1. Our work provides evidence for RAG-mediated IKZF1 Δ3-6 deletion. Our results raise the prospect that RAG is a valuable biomarker in disease surveillance. Dissecting the contribution of RAG should not only provide valuable mechanistic insights, but will also lead to a new therapeutic direction.
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Affiliation(s)
- Y Dong
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - F Liu
- Department of Hematology, Xi'an Central Hospital
| | - C Wu
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - S Li
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - X Zhao
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - P Zhang
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - J Jiao
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - X Yu
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - Y Ji
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center.,Ministry of Education of China, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)
| | - M Zhang
- Department of Hematology, the First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
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11
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Guillory T, Li S, Bergsagel DJ, Weinzierl E, Bunting ST. Hematogones With Lambda Light Chain Restriction in a 4-Year-Old Boy With Burkitt Lymphoma: A Potential Diagnostic Pitfall. Lab Med 2016; 47:163-70. [PMID: 27069035 PMCID: PMC4832592 DOI: 10.1093/labmed/lmw009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hematogones are immature normal B cell precursors with a characteristic immunophenotype profile on flow cytometry that typically do not express surface immunoglobulin light chains. In this report, we describe a case in which the hematogones exhibit light chain restriction. Our patient was a 4-year-old boy with a complicated medical history involving treatment for a presumed bilateral Wilms tumor of the kidney that on later resection was diagnosed as Burkitt lymphoma. Flow cytometry analysis of his bone marrow revealed a small distinct population of cells expressing dim cluster of differentiation (CD)10, CD19, CD22, CD38, dim CD58, human leukocyte antigen-D related (HLA-DR), and dim CD45, which are characteristic of hematogones. These cells, however, demonstrated dim surface immunoglobulin lambda light-chain restriction. Molecular study results for immunoglobulin heavy and kappa light-chain gene rearrangements were negative. We present this case to raise awareness of the potential pitfalls of working up bone marrow for involvement by B cell lymphoproliferative disorder.
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Affiliation(s)
| | - Shiyong Li
- Department of Pathology, Emory University, Atlanta, GA
| | - Daniel J Bergsagel
- Division of Hematology/Oncology, Department of Pediatrics, AFLAC Cancer and Blood Disorder Center, Emory University, Atlanta, GA
| | - Elizabeth Weinzierl
- Department of Pathology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Silvia T Bunting
- Department of Pathology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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Sajaroff EO, Mansini A, Rubio P, Alonso CN, Gallego MS, Coccé MC, Eandi-Eberle S, Bernasconi AR, Ampatzidou M, Paterakis G, Papadhimitriou SI, Petrikkos L, Papadakis V, Polychronopoulou S, Rossi JG, Felice MS. B-cell acute lymphoblastic leukemia with mature phenotype and MLL rearrangement: report of five new cases and review of the literature. Leuk Lymphoma 2016; 57:2289-97. [PMID: 26857438 DOI: 10.3109/10428194.2016.1141407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The association between mature-B phenotype and MLL abnormalities in acute lymphoblastic leukemia (ALL) is a very unusual finding; only 14 pediatric cases have been reported so far. We describe the clinical and biological characteristics and outcome of five pediatric cases of newly diagnosed B lineage ALL with MLL abnormalities and mature immunophenotype based on light chain restriction and surface Ig expression. Blasts showed variable expression of CD10/CD34/TdT. MLL abnormalities with no MYC involvement were detected in all patients by G-banding, FISH, and/or RT-PCR. Three patients were treated according to Interfant protocol, one to ALLIC-09, and one received B-NHL-BFM-2004. All patients achieved complete remission and three of them relapsed. Despite the small cohort size, it could be postulated that B lineage ALL with MLL abnormalities and mature phenotype is a distinct entity that differs both from the typical Pro B ALL observed in infants and mature B-ALL with high MYC expression.
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Affiliation(s)
- Elisa Olga Sajaroff
- a Department of Immunology and Rheumatology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Adrian Mansini
- b Department of Hematology-Oncology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Patricia Rubio
- b Department of Hematology-Oncology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Cristina Noemí Alonso
- b Department of Hematology-Oncology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Marta S Gallego
- c Cytogenetics Laboratory, Department of Genetics , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Mariela C Coccé
- c Cytogenetics Laboratory, Department of Genetics , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Silvia Eandi-Eberle
- b Department of Hematology-Oncology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Andrea Raquel Bernasconi
- a Department of Immunology and Rheumatology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Maria Ampatzidou
- d Department of Pediatric Hematology-Oncology (TAO) , Aghia Sophia ChildreńS Hospital , Athens , Greece
| | - George Paterakis
- e Department of Flow Cytometry, Laboratory of Immunology , "G. Gennimatas" General Hospital , Athens , Greece
| | - Stefanos I Papadhimitriou
- f Laboratory of Hematology, Department of Molecular Cytogenetics , "G. Gennimatas" General Hospital , Athens , Greece
| | - Loizos Petrikkos
- d Department of Pediatric Hematology-Oncology (TAO) , Aghia Sophia ChildreńS Hospital , Athens , Greece
| | - Vassilios Papadakis
- d Department of Pediatric Hematology-Oncology (TAO) , Aghia Sophia ChildreńS Hospital , Athens , Greece
| | - Sophia Polychronopoulou
- d Department of Pediatric Hematology-Oncology (TAO) , Aghia Sophia ChildreńS Hospital , Athens , Greece
| | - Jorge G Rossi
- a Department of Immunology and Rheumatology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
| | - Maria Sara Felice
- b Department of Hematology-Oncology , Hospital De Pediatría Prof. Dr. Juan P. Garrahan , Buenos Aires , Argentina
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Deucher AM, Qi Z, Yu J, George TI, Etzell JE. BCL6 expression correlates with the t(1;19) translocation in B-lymphoblastic leukemia. Am J Clin Pathol 2015; 143:547-57. [PMID: 25780007 DOI: 10.1309/ajcpo4u4vyaaotel] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Study to date suggests that BCL6 protein expression in B-cell neoplasia predominates in germinal center-derived tumors, but less is known regarding its expression in B-lymphoblastic leukemia. Therefore, we designed a comprehensive study of BCL6 expression in B-lymphoblastic leukemia. METHODS BCL6, LMO, and HGAL protein expression in B-lymphoblastic leukemia was investigated using immunohistochemical staining of paraffin-embedded bone marrow specimens. Cryptic TCF3(E2A)-PBX1 rearrangements were investigated using interphase fluorescence in situ hybridization. RESULTS Six (12%) of 52 B-lymphoblastic leukemias demonstrated BCL6 protein expression, with B-cell lymphoblastic leukemias containing a t(1;19) translocation demonstrating the strongest staining (three of three). Additional t(1;19) cases beyond the screening study showed similar results. Public microarray expression database mining showed that BCL6 messenger RNA expression levels in B-lymphoblastic leukemia correlated with the protein expression findings. Finally, other markers of B-cell development correlated with BCL6 expression in t(1;19) B-lymphoblastic leukemia cases, with LMO2 and HGAL proteins expressed in six (67%) of nine and eight (89%) of nine cases, respectively. CONCLUSIONS BCL6 expression is present in a subset of B-lymphoblastic leukemias, especially in cases containing the 1;19 translocation. Investigation for TCF3(E2A)-PBX1 rearrangements may be useful in BCL6-positive B-lymphoblastic leukemia.
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Kim B, Lee ST, Kim HJ, Lee SH, Yoo KH, Koo HH, Kim SH. Acute lymphoblastic leukemia with mature B-cell phenotype and t(9;11;11)(p22;q23;p11.2): a case study and literature review. Ann Lab Med 2014; 34:166-9. [PMID: 24624357 PMCID: PMC3948834 DOI: 10.3343/alm.2014.34.2.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/19/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Borahm Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Hyun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Lam JT, Jackson CC, Cruse JM, Young-Gaylor LD. A leukemia/lymphoma with lymphoblastic morphology and l3 morphologic relapse. Pediatr Hematol Oncol 2011; 28:523-5. [PMID: 21728719 DOI: 10.3109/08880018.2011.578204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Abstract
The evaluation of pediatric bone marrow poses specific challenges when compared with the general adult population. These challenges stem in part from the higher likelihood of congenital disorders with hematopoietic manifestations, some of which may give rise to hematologic malignancies. Familiarity with the spectrum of disorders seen in the pediatric age group allows for an appropriate and focused differential diagnosis. This review addresses the diagnostic workup of pediatric bone marrow samples, as directed by the peripheral blood and bone marrow findings in the context of the patient's clinical history. Recommendations for the appropriate use of ancillary studies in various scenarios are provided.
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Affiliation(s)
- Mihaela Onciu
- Department of Pathology, MS 250, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
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18
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Mature B-cell lymphoblastic leukemia with MLL rearrangement: an uncommon and distinct subset of childhood acute leukemia. Leukemia 2007; 22:1056-9. [PMID: 18007578 DOI: 10.1038/sj.leu.2404992] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nelson BP, Treaba D, Goolsby C, Williams S, Dewald G, Gordon L, Peterson LC. Surface immunoglobulin positive lymphoblastic leukemia in adults; a genetic spectrum. Leuk Lymphoma 2007; 47:1352-9. [PMID: 16923568 DOI: 10.1080/10428190500473238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Precursor B-lymphoblastic leukemia is typically surface immunoglobulin (sIg) negative. Although rare cases of sIg+ precursor lymphoblastic leukemia are recognized, sIg+ leukemia often represent leukemic phase of Burkitt lymphoma or other non-Hodgkin lymphoma such as blastic mantle cell lymphoma. This study reports four adults, two women (56 and 58 years old) and two men (35 and 41 years old) with lymphoblastic leukemia that displayed lambda, surface immunoglobulin restriction (sIg+). The leukemic cells were all dim CD45 positive with side scatter light characteristic of blasts. Two cases were positive with the blasts associated with antigens TdT and CD34. Genetic abnormalities were detected in all cases and in three cases included abnormalities commonly present in precursor lymphoblastic leukemia. Translocation (1;19) (q23;p13) was present in the first case. Deletion of the 3' region of the mixed lineage leukemia (MLL) gene at chromosome 11q23 as well as t(14;18) were detected in the second case. In the 3rd case, a BCR-ABL fusion gene was detected as part of a complex abnormal karyotype. Translocation (1;19)(q23;p13) was present in one case. Deletion of the 3' region of the mixed lineage leukemia (MLL) gene at chromosome 11q23 as well as t(14;18) were detected in one case. BCR-ABL fusion gene was detected as part of a complex abnormal karyotype in one case. These cases illustrate that lymphoblastic leukemias occurring in adults exhibit a morphologic, immunophenotypic as well as a genetic spectrum and represent either non-Hodgkin lymphoma or precursor lymphoblastic leukemia. A multi-parameter approach including flow cytometric and genetic studies is crucial in separating these cases.
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Affiliation(s)
- Beverly P Nelson
- Department of Pathology, Northwestern University, Chicago, IL 60611-2908, USA.
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Affiliation(s)
- April Chiu
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
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Chng WJ, Yeoh AEJ, Liu TC, Quah TC. t(8;14) Mature B-cell (Burkitt's) lymphoma/leukaemia with atypical morphology in a paediatric patient. Eur J Haematol 2004; 73:386-7. [PMID: 15458521 DOI: 10.1111/j.1600-0609.2004.00303.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Lymphoblastic leukemias with surface immunoglobulin light chain expression and L1/L2 blast morphology (French-American-British Classification) are rare. The poor prognosis of lymphoblastic leukemia in children under 1 year of age is attributed largely to rearrangements involving the mixed lineage leukemia (mll, also known as all1, htrx, trx1, or hrx) gene that occur with increased frequency in this population. Mll-rearranged cases with a mature B-cell phenotype are rare. The authors describe an infant with mature B-cell lymphoblastic leukemia with an mll rearrangement and L1/L2 cytomorphology and discuss the clinical, genetic, and immunophenotypic features in the context of previously reported cases.
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Gupta AA, Grant R, Shago M, Abdelhaleem M. Occurrence of t(8;22)(q24.1;q11.2) involving the MYC locus in a case of pediatric acute lymphoblastic leukemia with a precursor B cell immunophenotype. J Pediatr Hematol Oncol 2004; 26:532-4. [PMID: 15284595 DOI: 10.1097/01.mph.0000132736.31514.28] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a child with clinical presentation of acute leukemia and an immunophenotype consistent with precursor B-cell acute lymphoblastic leukemia. However, the lymphoblasts had atypical L3 features and the chromosome rearrangement t(8;22)(q24.1;q11.2) involving the MYC locus. The cytogenetic features in this patient were characteristic of mature B/Burkitt leukemia and led to modulation of therapy. This case highlights the need for timely cytogenetic and molecular studies in the diagnosis of acute leukemia.
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Affiliation(s)
- Abha A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
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Tsao L, Draoua HY, Osunkwo I, Nandula SV, Murty VVS, Mansukhani M, Bhagat G, Alobeid B. Mature B-cell acute lymphoblastic leukemia with t(9;11) translocation: a distinct subset of B-cell acute lymphoblastic leukemia. Mod Pathol 2004; 17:832-9. [PMID: 15098014 DOI: 10.1038/modpathol.3800128] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mature B-cell acute lymphoblastic leukemia (ALL) is typically associated with the FAB-L3 morphology and rearrangement of the MYC gene, features characteristic of the leukemic phase of Burkitt's lymphoma. However, the term 'mature' has also been used to describe other rare cases of B-ALL with light-chain surface immunoglobulin expression. In contrast, infantile B-cell ALL is generally characterized by rearrangement of the MLL gene, an immature pro-B-cell phenotype, and CD10 negativity. We describe two unusual cases of infantile B-ALL with non-L3 morphology, expressing a mature B-cell phenotype (lambda sIg+, CD19+, CD10-, TdT-, and CD34-), and showing MLL rearrangement without MYC rearrangement at presentation. Both infants relapsed after months of morphologic and genetic remission. At relapse, the t(9;11) translocation was detected in both cases by spectral karyotyping. After the initial relapse, both cases followed a rapid and aggressive course. Literature search identified few similar cases, all expressed lambda surface immunoglobulin and showed MLL rearrangement (majority with the t(9;11) translocation). These cases show that B-ALL with MLL rearrangement, especially the t(9;11) translocation, can express a 'mature' B-cell phenotype and may represent a distinct subset. Identification of additional cases will further clarify the significance of MLL rearrangements in mature B-ALL.
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Affiliation(s)
- Lawrence Tsao
- Department of Pathology, Columbia University, New York, NY 10032, USA
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