HAEM5:B-lymphoblastic leukaemia/lymphoma with hypodiploidy: Difference between revisions

This entity is defined by the presence of neoplastic lymphoblasts containing less than 46 chromosomes<ref name=":0">Borowitz MJ, et al., (2017). B-Lymphoblastic leukaemia/lymphoma with recurrent genetic abnormalities, in World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. IARC Press: Lyon, France, p206.</ref>, and can be subdivided into near-haploid B-ALL/LBL with hypodiploidy (24–31 chromosomes); low-hypodiploid B-ALL/LBL with hypodiploidy (32–39 chromosomes); and high-hypodiploid B-ALL/LBL with hypodiploidy (40–43 chromosomes)<ref name=":13" />. Of note, near-diploid cases (44–45 chromosomes) are not included in the hypodiploid category in clinical therapy–directed classification schemes because they do not share the poor prognosis observed<ref name=":14" />. In a study, for patients with 44 chromosomes, monosomy 7, the presence of a dicentric chromosome, or both predicted a worse even free survival (EFS) but similar overall survival (OS)<ref name=":3">{{Cite journal|last=Nachman|first=James B.|last2=Heerema|first2=Nyla A.|last3=Sather|first3=Harland|last4=Camitta|first4=Bruce|last5=Forestier|first5=Erik|last6=Harrison|first6=Christine J.|last7=Dastugue|first7=Nicole|last8=Schrappe|first8=Martin|last9=Pui|first9=Ching-Hon|date=2007|title=Outcome of treatment in children with hypodiploid acute lymphoblastic leukemia|url=https://www.ncbi.nlm.nih.gov/pubmed/17473063|journal=Blood|volume=110|issue=4|pages=1112–1115|doi=10.1182/blood-2006-07-038299|issn=0006-4971|pmc=1939895|pmid=17473063}}</ref>.

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'''Note: A slight variation in the range of chromosome number has been reported in the literature in the classification of NH, LH, HH and NH'''<ref name=":0" /><ref name=":1">{{Cite journal|last=Terwilliger|first=T.|last2=Abdul-Hay|first2=M.|date=2017|title=Acute lymphoblastic leukemia: a comprehensive review and 2017 update|url=https://www.ncbi.nlm.nih.gov/pubmed/28665419|journal=Blood Cancer Journal|volume=7|issue=6|pages=e577|doi=10.1038/bcj.2017.53|issn=2044-5385|pmc=5520400|pmid=28665419}}</ref><ref name=":2" /><ref name=":5" /><ref name=":3" /><ref>{{Cite journal|last=Safavi|first=Setareh|last2=Paulsson|first2=Kajsa|date=2017|title=Near-haploid and low-hypodiploid acute lymphoblastic leukemia: two distinct subtypes with consistently poor prognosis|url=https://www.ncbi.nlm.nih.gov/pubmed/27903530|journal=Blood|volume=129|issue=4|pages=420–423|doi=10.1182/blood-2016-10-743765|issn=1528-0020|pmid=27903530}}</ref><ref>{{Cite journal|last=Mehta|first=Parinda A.|last2=Zhang|first2=Mei-Jie|last3=Eapen|first3=Mary|last4=He|first4=Wensheng|last5=Seber|first5=Adriana|last6=Gibson|first6=Brenda|last7=Camitta|first7=Bruce M.|last8=Kitko|first8=Carrie L.|last9=Dvorak|first9=Christopher C.|date=2015|title=Transplantation Outcomes for Children with Hypodiploid Acute Lymphoblastic Leukemia|url=https://www.ncbi.nlm.nih.gov/pubmed/25865650|journal=Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation|volume=21|issue=7|pages=1273–1277|doi=10.1016/j.bbmt.2015.04.008|issn=1523-6536|pmc=4465998|pmid=25865650}}</ref><ref>{{Cite journal|last=Mullighan|first=Charles G.|date=2012|title=Molecular genetics of B-precursor acute lymphoblastic leukemia|url=https://www.ncbi.nlm.nih.gov/pubmed/23023711|journal=The Journal of Clinical Investigation|volume=122|issue=10|pages=3407–3415|doi=10.1172/JCI61203|issn=1558-8238|pmc=3461902|pmid=23023711}}</ref><ref>{{Cite journal|last=Harrison|first=Christine J.|last2=Moorman|first2=Anthony V.|last3=Broadfield|first3=Zoë J.|last4=Cheung|first4=Kan L.|last5=Harris|first5=Rachel L.|last6=Reza Jalali|first6=G.|last7=Robinson|first7=Hazel M.|last8=Barber|first8=Kerry E.|last9=Richards|first9=Sue M.|date=2004|title=Three distinct subgroups of hypodiploidy in acute lymphoblastic leukaemia|url=https://www.ncbi.nlm.nih.gov/pubmed/15147369|journal=British Journal of Haematology|volume=125|issue=5|pages=552–559|doi=10.1111/j.1365-2141.2004.04948.x|issn=0007-1048|pmid=15147369}}</ref><ref>{{Cite journal|last=Wang|first=Yunhong|last2=Miller|first2=Sue|last3=Roulston|first3=Diane|last4=Bixby|first4=Dale|last5=Shao|first5=Lina|date=2016|title=Genome-Wide Single-Nucleotide Polymorphism Array Analysis Improves Prognostication of Acute Lymphoblastic Leukemia/Lymphoma|url=https://www.ncbi.nlm.nih.gov/pubmed/27161658|journal=The Journal of molecular diagnostics: JMD|volume=18|issue=4|pages=595–603|doi=10.1016/j.jmoldx.2016.03.004|issn=1943-7811|pmid=27161658}}</ref><ref name=":9">{{Cite journal|last=Safavi|first=Setareh|last2=Olsson|first2=Linda|last3=Biloglav|first3=Andrea|last4=Veerla|first4=Srinivas|last5=Blendberg|first5=Molly|last6=Tayebwa|first6=Johnbosco|last7=Behrendtz|first7=Mikael|last8=Castor|first8=Anders|last9=Hansson|first9=Markus|date=2015|title=Genetic and epigenetic characterization of hypodiploid acute lymphoblastic leukemia|url=https://www.ncbi.nlm.nih.gov/pubmed/26544893|journal=Oncotarget|volume=6|issue=40|pages=42793–42802|doi=10.18632/oncotarget.6000|issn=1949-2553|pmc=4767471|pmid=26544893}}</ref> <ref name=":12">{{Cite journal|last=Moorman|first=Anthony V.|date=2016|title=New and emerging prognostic and predictive genetic biomarkers in B-cell precursor acute lymphoblastic leukemia|url=https://www.ncbi.nlm.nih.gov/pubmed/27033238|journal=Haematologica|volume=101|issue=4|pages=407–416|doi=10.3324/haematol.2015.141101|issn=1592-8721|pmc=5004393|pmid=27033238}}</ref><ref>{{Cite journal|last=Fang|first=Min|last2=Becker|first2=Pamela S.|last3=Linenberger|first3=Michael|last4=Eaton|first4=Keith D.|last5=Appelbaum|first5=Frederick R.|last6=Dreyer|first6=ZoAnn|last7=Airewele|first7=Gladstone|last8=Redell|first8=Michele|last9=Lopez-Terrada|first9=Dolores|date=2015|title=Adult Low-Hypodiploid Acute B-Lymphoblastic Leukemia With IKZF3 Deletion and TP53 Mutation: Comparison With Pediatric Patients|url=https://www.ncbi.nlm.nih.gov/pubmed/26185311|journal=American Journal of Clinical Pathology|volume=144|issue=2|pages=263–270|doi=10.1309/AJCPW83OXPYKPEEN|issn=1943-7722|pmid=26185311}}</ref><ref name=":6">{{Cite journal|last=Mühlbacher|first=Verena|last2=Zenger|first2=Melanie|last3=Schnittger|first3=Susanne|last4=Weissmann|first4=Sandra|last5=Kunze|first5=Franziska|last6=Kohlmann|first6=Alexander|last7=Bellos|first7=Frauke|last8=Kern|first8=Wolfgang|last9=Haferlach|first9=Torsten|date=2014|title=Acute lymphoblastic leukemia with low hypodiploid/near triploid karyotype is a specific clinical entity and exhibits a very high TP53 mutation frequency of 93%|url=https://www.ncbi.nlm.nih.gov/pubmed/24619868|journal=Genes, Chromosomes & Cancer|volume=53|issue=6|pages=524–536|doi=10.1002/gcc.22163|issn=1098-2264|pmid=24619868}}</ref><ref>{{Cite journal|last=Woo|first=Jennifer S.|last2=Alberti|first2=Michael O.|last3=Tirado|first3=Carlos A.|date=2014|title=Childhood B-acute lymphoblastic leukemia: a genetic update|url=https://www.ncbi.nlm.nih.gov/pubmed/24949228|journal=Experimental Hematology & Oncology|volume=3|pages=16|doi=10.1186/2162-3619-3-16|issn=2162-3619|pmc=4063430|pmid=24949228}}</ref><ref>{{Cite journal|last=Collins-Underwood|first=J. R.|last2=Mullighan|first2=C. G.|date=2010|title=Genomic profiling of high-risk acute lymphoblastic leukemia|url=https://www.ncbi.nlm.nih.gov/pubmed/20739952|journal=Leukemia|volume=24|issue=10|pages=1676–1685|doi=10.1038/leu.2010.177|issn=1476-5551|pmid=20739952}}</ref><ref name=":4">Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD (2018). Acute lymphoblastic  leukemia (ALL). Medscape. emedicine, Medscape Article, Drugs & Diseases, Hematology.</ref>  '''[1-17].'''</blockquote>In addition, lymphoid transcription factor gene ''IKZF3'' (13%, encoding AIOLOS) and deletions of histone cluster at 6p22 (19%) were also reported<ref name=":2" />. In low hypodiploid (LH) ALL mutations involved ''TP53'' (91.2%) and ''IKZF2'' (53%, encoding HELIOS, 2q34), and ''RB1'' genes (41%) loci<ref name=":2" />. Both NH and LH had activation of RAS signaling and P13K signaling pathways and sensitive to P13K inhibitors indicating these drugs may offer a new therapeutic option<ref name=":2" />. Inn this group, several studies have not only identified a high percentage of pediatric patients with ''TP53'' mutations, but close to half displayed germline mutations, suggesting that LH ALL is a manifestation of Li-Fraumeni syndrome in children.  Adults also showed a high incidence of ''TP53'' (91%) in low hypodiploid ALL mutations, but these mutations appear to be somatic in origin. In NH, mutations appear in genes involving receptor tyrosine kinase (RTK) pathway, Ras signaling, ''IKZF3'' (17q21.1), and histone clusters, but rarely ''IZFK2'', ''RB1'', or ''TP53''<ref name=":2" />.