PCR- Negative Atypical PML-RARA Rearrangement in Pediatric Acute Promyelocytic Leukemia
DOI:
https://doi.org/10.30683/1929-2279.2021.10.07Keywords:
Acute promyelocytic leukemia, diagnosis, PML-RARA, FISH, t (15; 17)Abstract
Acute promyelocytic leukemia (APL) is a special type of acute myeloid leukemia (AML), accounting for about 5% to 10% of children with AML. At the genetic level, APL is featured by a unique chromosome translocation t(15;17) which results in the PML-RARA gene fusion. Most patients can be diagnosed by traditional karyotype analysis, Fluorescence-In-Situ Hybridization (FISH), or Reverse Transcription-Polymerase Chain Reaction (RT-PCR). We report the case of a child with acute promyelocytic leukemia (APL) who had characteristic chromosome translocation t(15;17) and rare PML-RARA gene mutation. This patient had an excellent response to chemotherapy, suggesting that this mutation will not affect the treatment and prognosis of APL.
References
Taga T, Tomizawa D, Takahashi H, Adachi S. Acute myeloid leukemia in children: Current status and future directions. Pediatr Int 2016; 58: 71-80. https://doi.org/10.1111/ped.12865 DOI: https://doi.org/10.1111/ped.12865
Lo-Coco F, Hasan SK. Understanding the molecular pathogenesis of acute promyelocytic leukemia. Best Pract Res Clin Haematol 2014; 27: 3-9. https://doi.org/10.1016/j.beha.2014.04.006 DOI: https://doi.org/10.1016/j.beha.2014.04.006
De Braekeleer E, Douet-Guilbert N, De Braekeleer M. RARA fusion genes in acute promyelocytic leukemia: a review. Expert Rev Hematol 2014; 7: 347-357. https://doi.org/10.1586/17474086.2014.903794 DOI: https://doi.org/10.1586/17474086.2014.903794
Hui J. Examination and diagnosis of acute promyelocytic leukemia. Chinese Journal of Pediatric Hematology and Oncology 2019; 24: 116-118.
Park JH, Qiao B, Panageas KS, Schymura MJ, Jurcic JG, Rosenblat TL, Altman JK, Douer D, Rowe JM, Tallman MS. The early death rate in acute promyelocytic leukemia remains high despite all-trans retinoic acid. Blood 2011; 118: 1248-1254. https://doi.org/10.1182/blood-2011-04-346437 DOI: https://doi.org/10.1182/blood-2011-04-346437
Specification for the Diagnosis and Treatment of Acute Promyelocytic Leukemia in Children (2018 Edition). Chinese Journal of Pediatrics 2019; 757-760.
Lewis C, Patel V, Abhyankar S, Zhang D, Ketterling RP, McClure RF, Persons DL. Microgranular variant of acute promyelocytic leukemia with normal conventional cytogene-tics, negative PML/RARA FISH and positive PML/RARA transcripts by RT-PCR. Cancer Genet 2011; 204: 522-523. https://doi.org/10.1016/j.cancergen.2011.09.001 DOI: https://doi.org/10.1016/j.cancergen.2011.09.001
Schultz MJ, Blackburn PR, Cogbill CH, Pitel BA, Smadbeck JB, Johnson SH, Vasmatzis G, Rech KL, Sukov WR, Greipp PT, et al.. Characterization of a cryptic fusion by mate-pair sequencing in a case of acute promyelocytic leukemia with a normal karyotype and negative FISH studies. Leuk Lymphoma 2020; 61: 975-978. https://doi.org/10.1080/10428194.2019.1699081 DOI: https://doi.org/10.1080/10428194.2019.1699081
Avgerinou G, Katsibardi Κ, Filippidou M, Tzanoudaki M, Papadhimitriou SI, Kattamis A. Cytogenetically cryptic and fish negative PML/RARA rearrangement in acute promyelocytic leukemia detected by RT-PCR. Leuk Lymphoma 2020; 61: 3526-3528. https://doi.org/10.1080/10428194.2020.1808202 DOI: https://doi.org/10.1080/10428194.2020.1808202
Kim MJ, Cho SY, Kim M-H, Lee JJ, Kang SY, Cho EH, Huh J, Yoon H-J, Park TS, Lee W-I, et al. FISH-negative cryptic PML-RARA rearrangement detected by long-distance polymerase chain reaction and sequencing analyses: a case study and review of the literature. Cancer Genet Cytogenet 2010; 203: 278-283. https://doi.org/10.1016/j.cancergencyto.2010.08.026 DOI: https://doi.org/10.1016/j.cancergencyto.2010.08.026
Blanco EM, Curry CV, Lu XY, Sarabia SF, Redell MS, Lopez-Terrada DH, Roy A. Cytogenetically cryptic and FISH-negative PML/RARA rearrangement in acute promyelocytic leukemia detected only by PCR: an exceedingly rare phenomenon. Cancer Genet 2014; 207: 48-49. https://doi.org/10.1016/j.cancergen.2014.01.001 DOI: https://doi.org/10.1016/j.cancergen.2014.01.001
Campbell LJ, Oei P, Brookwell R, Shortt J, Eaddy N, Ng A, Chew E, Browett P. FISH detection of PML-RARA fusion in ins(15;17) acute promyelocytic leukaemia depends on probe size. Biomed Res Int 2013; 2013: 164501. https://doi.org/10.1155/2013/164501 DOI: https://doi.org/10.1155/2013/164501
Gabert J, Beillard E, van der Velden VHJ, Bi W, Grimwade D, Pallisgaard N, Barbany G, Cazzaniga G, Cayuela JM, Cavé H, et al. Standardization and quality control studies of 'real-time' quantitative reverse transcriptase polymerase chain reaction of fusion gene transcripts for residual disease detection in leukemia - a Europe. Against Cancer program Leukemia 2003; 17: 2318-2357. https://doi.org/10.1038/sj.leu.2403135 DOI: https://doi.org/10.1038/sj.leu.2403135
Jianwen X, Ying X, Yuxia G, Xianmin G. Two rare cases of PML/RARα fusion gene in children with acute promyelocytic leukemia. International Journal of Laboratory Medicine 2015; 36: 1636-1638.
Iaccarino L, Divona M, Ottone T, Cicconi L, Lavorgna S, Ciardi C, Alfonso V, Travaglini S, Facchini L, Cimino G, et al. Identification and monitoring of atypical PML/RARA fusion transcripts in acute promyelocytic leukemia. Genes Chromosomes Cancer 2019; 58: 60-65. https://doi.org/10.1002/gcc.22708 DOI: https://doi.org/10.1002/gcc.22708
Hongxia S, Jing X, Guoliang H, Sanchun L, Zhiqiang Z. Acute promyelocytic leukemia of V. PML-RARA gene: A case report and review of the literature. Journal of Clinical Laboratory 2021; 39: 156-158.
Cao Y, Yao L, Liu Y, Gu Q, Dong W, Wang Z, Wang F, Lin R, Xie X, Cen J, et al. An Atypical PML-RARA Rearrangement Resulting from Submicroscopic Insertion of the RARA Gene at the PML Locus with Novel Breakpoints within PML Exon 7b and RARA Exon 3. Acta Haematol 2019; 142. https://doi.org/10.1159/000498842 DOI: https://doi.org/10.1159/000498842
Chengye W, Yulong L, Xiaoyan D, Lin Z, Baojun S. Acute promyelocytic leukemia with PML hidden breakpoint t(15; 17)(q22; q21): a case report and review of the literature. Chinese Journal of Hematology 2021; 42: 74-77.
Ismail S, Ababneh N, Awidi A. Identification of atypical PML-RARA breakpoint in a patient with acute promyelocytic leukemia. Acta Haematol 2007; 118: 183-187. https://doi.org/10.1159/000109471 DOI: https://doi.org/10.1159/000109471