HAEM5:Myelodysplastic neoplasm with low blasts and 5q deletion: Difference between revisions

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{{DISPLAYTITLE:Myelodysplastic neoplasm with low blasts and 5q deletion}}
{{DISPLAYTITLE:Myelodysplastic neoplasm with low blasts and 5q deletion}}
[[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]]
[[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]]


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<blockquote class='blockedit'>{{Box-round|title=Content Update To WHO 5th Edition Classification Is In Process; Content Below is Based on WHO 4th Edition Classification|This page was converted to the new template on 2023-12-07. The original page can be found at [[HAEM4:Myelodysplastic Syndrome (MDS) with Isolated del(5q)]].
<blockquote class="blockedit">{{Box-round|title=Content Update To WHO 5th Edition Classification Is In Process; Content Below is Based on WHO 4th Edition Classification|This page was converted to the new template on 2023-12-07. The original page can be found at [[HAEM4:Myelodysplastic Syndrome (MDS) with Isolated del(5q)]].
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==Definition / Description of Disease==
MDS with isolated del(5q) is a type of [[HAEM4:Myelodysplastic Syndromes (MDS)|MDS]] with defining cytogenetic abnormality of del(5q). The World Health Organization named it as isolated del 5q, but occasionally the deletion can occur with an additional cytogenetic abnormality other than monosomy 7 or del(7q). The 5q- syndrome was first described by Van den Berghe et al as a distinct type of MDS featured with macrocytic anemia, hypolobulated megakaryocytes, a normal or increased platelet count <ref name=":0" />. Deletion of 5q is the most common recurrent cytogenetic abnormality in myeloid neoplasm and it was commonly seen in 10-15% of patients with MDS<ref>{{Cite journal|last=Hosono|first=Naoko|last2=Makishima|first2=Hideki|last3=Mahfouz|first3=Reda|last4=Przychodzen|first4=Bartlomiej|last5=Yoshida|first5=Kenichi|last6=Jerez|first6=Andres|last7=LaFramboise|first7=Thomas|last8=Polprasert|first8=Chantana|last9=Clemente|first9=Michael J|date=2017|title=Recurrent genetic defects on chromosome 5q in myeloid neoplasms|url=https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.14130|journal=Oncotarget|language=en|volume=8|issue=4|pages=6483–6495|doi=10.18632/oncotarget.14130|issn=1949-2553|pmc=PMC5351647|pmid=28031539}}</ref>. A ~1.5 Mb common deleted region (CDR)  at 5q32-q33 was identified in 5q- syndrome patients and was associated with good prognosis <ref>{{Cite journal|last=Boultwood|first=J.|last2=Fidler|first2=C.|last3=Lewis|first3=S.|last4=Kelly|first4=S.|last5=Sheridan|first5=H.|last6=Littlewood|first6=T.J.|last7=Buckle|first7=V.J.|last8=Wainscoat|first8=J.S.|date=1994|title=Molecular Mapping of Uncharacteristically Small 5q Deletions in Two Patients with the 5q- Syndrome: Delineation of the Critical Region on 5q and Identification of a 5q- Breakpoint|url=https://linkinghub.elsevier.com/retrieve/pii/S0888754384710901|journal=Genomics|language=en|volume=19|issue=3|pages=425–432|doi=10.1006/geno.1994.1090}}</ref>. This disease has a good respond to lenalidomide treatment (See Clinical Significance). 
==Synonyms / Terminology==
Myelodysplastic syndromes with 5q deletion; 5q minus syndrome
==Epidemiology / Prevalence==
*Median age 67 years <ref>{{Cite journal|last=Giagounidis|first=A.A.N.|last2=Germing|first2=U.|last3=Wainscoat|first3=J.S.|last4=Boultwood|first4=J.|last5=Aul|first5=C.|date=2004|title=Hematological Malignancies|url=https://www.tandfonline.com/doi/full/10.1080/10245330410001723824|journal=Hematology|language=en|volume=9|issue=4|pages=271–277|doi=10.1080/10245330410001723824|issn=1607-8454}}</ref>
*Women versus male about 2:1
==Clinical Features==
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{| class="wikitable"
|'''Signs and Symptoms'''
|<span class="blue-text">EXAMPLE:</span> Asymptomatic (incidental finding on complete blood counts)
<span class="blue-text">EXAMPLE:</span> B-symptoms (weight loss, fever, night sweats)
<span class="blue-text">EXAMPLE:</span> Fatigue
<span class="blue-text">EXAMPLE:</span> Lymphadenopathy (uncommon)
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|'''Laboratory Findings'''
|<span class="blue-text">EXAMPLE:</span> Cytopenias
<span class="blue-text">EXAMPLE:</span> Lymphocytosis (low level)
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*Macrocytic anemia most common, usually severe and can be transfusion dependent.
*Thrombocytosis can be seen in 1/3 to 1/2 of cases, whereas thrombocytopenia or neutropenia are uncommon.
*Pancytopenia is rare. If pancytopenia with isolated 5q-, MDS with unclassifiable should be considered. [WHO]
*Good prognosis and low risk to progress to AML.
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==Sites of Involvement==
Blood or bone marrow
==Morphologic Features==
On bone marrow examination, cellularity is usually normal or hypercellular. Erythroid hypoplasia may be seen. Blasts cells are < 5% in the bone marrow and < 1% in the peripheral blood. The most characteristic feature of isolated 5q- is the presence of micromegakaryocytes with hypolobated nuclei [insert pic micromegakaryocyte]. The erythroid dysplasia may be seen but not predominant. Granulocytic dysplasia is uncommon.
Hypolobated micromegakaryocytes are also seen in CML, which is characterized by leukocytosis, basophilia, and myeloid hyperplasia with leftward shift. Platelet count increase can be seen in essential thrombocythemia (ET), but ET has large megakaryocytes with hyperlobulated nuclei rather than microkaryocytes with hypolobulation in MDS with isolated del(5q).
==Immunophenotype==
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!Finding!!Marker
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|Positive (universal)||<span class="blue-text">EXAMPLE:</span> CD1
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|Positive (subset)||<span class="blue-text">EXAMPLE:</span> CD2
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|Negative (universal)||<span class="blue-text">EXAMPLE:</span> CD3
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|Negative (subset)||<span class="blue-text">EXAMPLE:</span> CD4
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There is no distinct immunophenotypic profile specific for myelodysplastic syndrome (MDS) with isolated del(5q). Currently, morphologic evaluation remains the gold standard in diagnosis of MDS. Immunophenotyping provides supportive evidence to clarify the blasts nature and percentage <ref>{{Cite journal|last=Zini|first=Gina|date=2017|title=Diagnostics and Prognostication of Myelodysplastic Syndromes|url=https://synapse.koreamed.org/DOIx.php?id=10.3343/alm.2017.37.6.465|journal=Annals of Laboratory Medicine|language=en|volume=37|issue=6|pages=465|doi=10.3343/alm.2017.37.6.465|issn=2234-3806|pmc=PMC5587818|pmid=28840983}}</ref>.
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==WHO Essential and Desirable Genetic Diagnostic Criteria==
==WHO Essential and Desirable Genetic Diagnostic Criteria==
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<blockquote class='blockedit'>{{Box-round|title=v4:Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications).|Please incorporate this section into the relevant tables found in:
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* Chromosomal Rearrangements (Gene Fusions)
* Chromosomal Rearrangements (Gene Fusions)
* Individual Region Genomic Gain/Loss/LOH
* Individual Region Genomic Gain/Loss/LOH
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The most characteristic cytogenetic abnormality is an interstitial deletion on the long arm of chromosome 5 or del(5q)<ref name=":0">{{Cite journal|last=Van Den Berghe|first=Herman|last2=Cassiman|first2=Jean-Jacques|last3=David|first3=Guido|last4=Fryns|first4=Jean-Pierre|last5=Michaux|first5=Jean-Louis|last6=Sokal|first6=Gerard|date=1974|title=Distinct haematological disorder with deletion of long arm of No. 5 chromosome|url=http://www.nature.com/articles/251437a0|journal=Nature|language=en|volume=251|issue=5474|pages=437–438|doi=10.1038/251437a0|issn=0028-0836}}</ref>  The break point is not fixed but the region between bands q31 and q33 is generally deleted. Several candidates genes were thought to contribute to the haploinsufficiency effect of the deleted region, including ''RPS14'' <ref>{{Cite journal|last=Ebert|first=Benjamin L.|last2=Pretz|first2=Jennifer|last3=Bosco|first3=Jocelyn|last4=Chang|first4=Cindy Y.|last5=Tamayo|first5=Pablo|last6=Galili|first6=Naomi|last7=Raza|first7=Azra|last8=Root|first8=David E.|last9=Attar|first9=Eyal|date=2008|title=Identification of RPS14 as a 5q- syndrome gene by RNA interference screen|url=http://www.nature.com/articles/nature06494|journal=Nature|language=en|volume=451|issue=7176|pages=335–339|doi=10.1038/nature06494|issn=0028-0836|pmc=PMC3771855|pmid=18202658}}</ref>'', CSNK1A1'' <ref name=":1">{{Cite journal|last=Schneider|first=Rebekka K.|last2=Ademà|first2=Vera|last3=Heckl|first3=Dirk|last4=Järås|first4=Marcus|last5=Mallo|first5=Mar|last6=Lord|first6=Allegra M.|last7=Chu|first7=Lisa P.|last8=McConkey|first8=Marie E.|last9=Kramann|first9=Rafael|date=2014|title=Role of Casein Kinase 1A1 in the Biology and Targeted Therapy of del(5q) MDS|url=https://linkinghub.elsevier.com/retrieve/pii/S1535610814003353|journal=Cancer Cell|language=en|volume=26|issue=4|pages=509–520|doi=10.1016/j.ccr.2014.08.001|pmc=PMC4199102|pmid=25242043}}</ref>'','' miR-145 and miR-146a <ref>{{Cite journal|last=Starczynowski|first=Daniel T|last2=Kuchenbauer|first2=Florian|last3=Argiropoulos|first3=Bob|last4=Sung|first4=Sandy|last5=Morin|first5=Ryan|last6=Muranyi|first6=Andrew|last7=Hirst|first7=Martin|last8=Hogge|first8=Donna|last9=Marra|first9=Marco|date=2010|title=Identification of miR-145 and miR-146a as mediators of the 5q– syndrome phenotype|url=http://www.nature.com/articles/nm.2054|journal=Nature Medicine|language=en|volume=16|issue=1|pages=49–58|doi=10.1038/nm.2054|issn=1078-8956}}</ref>. Identification of del(5q) has clinical significance because patients with this cytogenetic abnormality have a good prognosis and they respond well to lenalidomide treatment.     
The most characteristic cytogenetic abnormality is an interstitial deletion on the long arm of chromosome 5 or del(5q)<ref name=":0">{{Cite journal|last=Van Den Berghe|first=Herman|last2=Cassiman|first2=Jean-Jacques|last3=David|first3=Guido|last4=Fryns|first4=Jean-Pierre|last5=Michaux|first5=Jean-Louis|last6=Sokal|first6=Gerard|date=1974|title=Distinct haematological disorder with deletion of long arm of No. 5 chromosome|url=http://www.nature.com/articles/251437a0|journal=Nature|language=en|volume=251|issue=5474|pages=437–438|doi=10.1038/251437a0|issn=0028-0836}}</ref>  The break point is not fixed but the region between bands q31 and q33 is generally deleted. Several candidates genes were thought to contribute to the haploinsufficiency effect of the deleted region, including ''RPS14'' <ref>{{Cite journal|last=Ebert|first=Benjamin L.|last2=Pretz|first2=Jennifer|last3=Bosco|first3=Jocelyn|last4=Chang|first4=Cindy Y.|last5=Tamayo|first5=Pablo|last6=Galili|first6=Naomi|last7=Raza|first7=Azra|last8=Root|first8=David E.|last9=Attar|first9=Eyal|date=2008|title=Identification of RPS14 as a 5q- syndrome gene by RNA interference screen|url=http://www.nature.com/articles/nature06494|journal=Nature|language=en|volume=451|issue=7176|pages=335–339|doi=10.1038/nature06494|issn=0028-0836|pmc=PMC3771855|pmid=18202658}}</ref>'', CSNK1A1'' <ref name=":1">{{Cite journal|last=Schneider|first=Rebekka K.|last2=Ademà|first2=Vera|last3=Heckl|first3=Dirk|last4=Järås|first4=Marcus|last5=Mallo|first5=Mar|last6=Lord|first6=Allegra M.|last7=Chu|first7=Lisa P.|last8=McConkey|first8=Marie E.|last9=Kramann|first9=Rafael|date=2014|title=Role of Casein Kinase 1A1 in the Biology and Targeted Therapy of del(5q) MDS|url=https://linkinghub.elsevier.com/retrieve/pii/S1535610814003353|journal=Cancer Cell|language=en|volume=26|issue=4|pages=509–520|doi=10.1016/j.ccr.2014.08.001|pmc=PMC4199102|pmid=25242043}}</ref>'','' miR-145 and miR-146a <ref>{{Cite journal|last=Starczynowski|first=Daniel T|last2=Kuchenbauer|first2=Florian|last3=Argiropoulos|first3=Bob|last4=Sung|first4=Sandy|last5=Morin|first5=Ryan|last6=Muranyi|first6=Andrew|last7=Hirst|first7=Martin|last8=Hogge|first8=Donna|last9=Marra|first9=Marco|date=2010|title=Identification of miR-145 and miR-146a as mediators of the 5q– syndrome phenotype|url=http://www.nature.com/articles/nm.2054|journal=Nature Medicine|language=en|volume=16|issue=1|pages=49–58|doi=10.1038/nm.2054|issn=1078-8956}}</ref>. Identification of del(5q) has clinical significance because patients with this cytogenetic abnormality have a good prognosis and they respond well to lenalidomide treatment.     


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|}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.
|}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.


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Somatic mutations in ''JAK2'' and ''MPL'' have been reported in a small subset patients with isolated del(5q), but these mutations seem not confer diagnostic or prognostic value <ref>{{Cite journal|last=Patnaik|first=M M|last2=Lasho|first2=T L|last3=Finke|first3=C M|last4=Gangat|first4=N|last5=Caramazza|first5=D|last6=Holtan|first6=S G|last7=Pardanani|first7=A|last8=Knudson|first8=R A|last9=Ketterling|first9=R P|date=2010|title=WHO-defined ‘myelodysplastic syndrome with isolated del(5q)’ in 88 consecutive patients: survival data, leukemic transformation rates and prevalence of JAK2, MPL and IDH mutations|url=http://www.nature.com/articles/leu2010105|journal=Leukemia|language=en|volume=24|issue=7|pages=1283–1289|doi=10.1038/leu.2010.105|issn=0887-6924|pmc=PMC3035970|pmid=20485371}}</ref>. A subset of cases could have ''[[SF3B1]]'' mutations, which needs to be differentiated with MDS-RS.
Somatic mutations in ''JAK2'' and ''MPL'' have been reported in a small subset patients with isolated del(5q), but these mutations seem not confer diagnostic or prognostic value <ref>{{Cite journal|last=Patnaik|first=M M|last2=Lasho|first2=T L|last3=Finke|first3=C M|last4=Gangat|first4=N|last5=Caramazza|first5=D|last6=Holtan|first6=S G|last7=Pardanani|first7=A|last8=Knudson|first8=R A|last9=Ketterling|first9=R P|date=2010|title=WHO-defined ‘myelodysplastic syndrome with isolated del(5q)’ in 88 consecutive patients: survival data, leukemic transformation rates and prevalence of JAK2, MPL and IDH mutations|url=http://www.nature.com/articles/leu2010105|journal=Leukemia|language=en|volume=24|issue=7|pages=1283–1289|doi=10.1038/leu.2010.105|issn=0887-6924|pmc=PMC3035970|pmid=20485371}}</ref>. A subset of cases could have ''[[SF3B1]]'' mutations, which needs to be differentiated with MDS-RS.
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Several candidate genes in the common deleted region of 5q have been reported to contribute to the molecular pathogenesis.
Several candidate genes in the common deleted region of 5q have been reported to contribute to the molecular pathogenesis.
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==Notes==
==Notes==
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<nowiki>*</nowiki>''Citation of this Page'': “Myelodysplastic neoplasm with low blasts and 5q deletion”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated {{REVISIONMONTH}}/{{REVISIONDAY}}/{{REVISIONYEAR}}, <nowiki>https://ccga.io/index.php/HAEM5:Myelodysplastic_neoplasm_with_low_blasts_and_5q_deletion</nowiki>.
<nowiki>*</nowiki>''Citation of this Page'': “Myelodysplastic neoplasm with low blasts and 5q deletion”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated {{REVISIONMONTH}}/{{REVISIONDAY}}/{{REVISIONYEAR}}, <nowiki>https://ccga.io/index.php/HAEM5:Myelodysplastic_neoplasm_with_low_blasts_and_5q_deletion</nowiki>.
[[Category:HAEM5]][[Category:DISEASE]][[Category:Diseases M]]
[[Category:HAEM5]]
[[Category:DISEASE]]
[[Category:Diseases M]]