1. Identification of a new cryptic PML-RARα fusion gene without t(15;17) and biallelic CEBPA mutation in a case of acute promyelocytic leukemia: a case detected only by RT-PCR but not cytogenetics and FISH
- Author
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Zhanglin Zhang, Zhi-Wei Chen, Shuyuan Liu, Fancong Kong, Fei Li, Mei Jiang, and Yawen Xu
- Subjects
Male ,0301 basic medicine ,Acute promyelocytic leukemia ,Cancer Research ,medicine.medical_specialty ,Oncogene Proteins, Fusion ,Chromosomal translocation ,T-15 ,Biology ,Translocation, Genetic ,Fusion gene ,03 medical and health sciences ,0302 clinical medicine ,Leukemia, Promyelocytic, Acute ,CEBPA ,medicine ,Humans ,In Situ Hybridization, Fluorescence ,Aged ,Pharmacology ,Chromosomes, Human, Pair 15 ,medicine.diagnostic_test ,Reverse Transcriptase Polymerase Chain Reaction ,Cytogenetics ,medicine.disease ,Bedside-to-Bench Report ,030104 developmental biology ,Real-time polymerase chain reaction ,Oncology ,030220 oncology & carcinogenesis ,Cytogenetic Analysis ,Mutation ,CCAAT-Enhancer-Binding Proteins ,Cancer research ,Molecular Medicine ,Chromosomes, Human, Pair 17 ,Fluorescence in situ hybridization - Abstract
Acute promyelocytic leukemia (APL) is characterized by the presence of promyelocytic leukemia-retinoic acid receptor α (PML-RARα) fusion gene, which is formed following the specific chromosomal translocation t(15;17)(q22;q21). However, cases with PML-RARα generated by occult t(15;17) which are negative by both cytogenetics and fluorescence in situ hybridization (FISH), are difficult to diagnose, leading to impaired treatment effectiveness. In the present study, we reported a case of a 66-year-old male patient, and bone marrow morphology, flow cytometry and cytogenetics did not support the diagnosis of APL. Molecular techniques, such as reverse-transcription polymerase chain reaction (RT-PCR), showed the existence of a cryptic PML-RARα fusion gene, and sequence analysis revealed a new variable isoform. Hotspot gene mutation analysis showed a biallelic CEBPA mutation. He received IA chemotherapy and all-trans retinoic acid (ATRA) treatment, and finally achieved complete remission. This case report provided valuable insights into the relevance of the correct identification of atypical PML–RARα fusion gene and biallelic CEBPA mutation. Moreover, combination of IA chemotherapy and ATRA treatment suggested a good clinical effect in this atypical PML–RARα.
- Published
- 2020
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