B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features

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Haematolymphoid Tumours (WHO Classification, 5th ed.)

editContent 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:B-Lymphoblastic Leukemia/Lymphoma, BCR-ABL1-Like.

(General Instructions – The focus of these pages is the clinically significant genetic alterations in each disease type. This is based on up-to-date knowledge from multiple resources such as PubMed and the WHO classification books. The CCGA is meant to be a supplemental resource to the WHO classification books; the CCGA captures in a continually updated wiki-stye manner the current genetics/genomics knowledge of each disease, which evolves more rapidly than books can be revised and published. If the same disease is described in multiple WHO classification books, the genetics-related information for that disease will be consolidated into a single main page that has this template (other pages would only contain a link to this main page). Use HUGO-approved gene names and symbols (italicized when appropriate), HGVS-based nomenclature for variants, as well as generic names of drugs and testing platforms or assays if applicable. Please complete tables whenever possible and do not delete them (add N/A if not applicable in the table and delete the examples); to add (or move) a row or column in a table, click nearby within the table and select the > symbol that appears. Please do not delete or alter the section headings. The use of bullet points alongside short blocks of text rather than only large paragraphs is encouraged. Additional instructions below in italicized blue text should not be included in the final page content. Please also see Author_Instructions and FAQs as well as contact your Associate Editor or Technical Support.)

Primary Author(s)*

Mark G. Evans, MD, Caris Life Sciences

Kilannin Krysiak, PhD, WashU Medicine

Sumire K. Kitahara, MD, Cedars-Sinai Medical Center

WHO Classification of Disease

Structure Disease
Book Haematolymphoid Tumours (5th ed.)
Category B-cell lymphoid proliferations and lymphomas
Family Precursor B-cell neoplasms
Type B-lymphoblastic leukaemias/lymphomas
Subtype(s) B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features

Related Terminology

Acceptable Philadelphia-like (Ph-like) B-ALL; BCR::ABL1-like B-ALL/LBL
Not Recommended N/A

Gene Rearrangements

B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features traditionally required diagnosis by gene expression (GEX) profiling[1][2] and was found to exhibit a GEX profile similar to Philadelphia chromosome-positive B-lymphoblastic leukaemia/lymphoma but lacking BCR::ABL1. The WHO[3] and ICC[4] have since recognized recurring genomic alterations associated with B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features, including ABL-class rearrangements, JAK-STAT activating alterations, and others. Proper identification of this disease is important, as patients may respond to targeted therapies like tyrosine kinase inhibitors (TKIs);[5] however, as most reports feature only single cases and limited series, consensus on the diagnostic/prognostic/therapeutic significance of the various genomic alterations has not been reached and currently being established.


Table derived from Akkari et al., 2020 [6] with permission from Cancer Genetics summarizes the important gene rearrangements associated with B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features.

3’ Partner 5’ Partner Chromosome rearrangement Gene fusion Visible by G-banding References Comment
ABL1

(9q34)

CENPC1 t(4;9)(q13;q34) CENPC1::ABL1 YES [7] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
ETV6 t(9;12)(q34;p13) ETV6::ABL1 NO [8] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
FOXP1 t(3;9)(p13;q34) FOXP1::ABL1 on der(3) YES [9]
LSM14A t(9;19)(q34;q13.1) LSM14A::ABL1 on der(19) YES [7]
NUP153 t(6;9)(p22.3;q34) NUP153::ABL1 on der(6) YES [7]
NUP214 dup(9)(q34.1q34.1) NUP214::ABL1 NO [10] Tandem duplication (~370 kb) detectable by CMA
RANBP2 t(2;9)(q12.3;q34) RANBP::ABL1 on der(2) YES [5]
RCSD1 t(1;9)(q24.2;q34) RCSD1::ABL1 on der(1) YES [11]
SFPQ t(1;9)(p34.3;q34) SFPQ::ABL1 on der(1) YES [12]
SNX1 t(9;15)(q34;q22.3) SNX1::ABL1 on der(15) YES [13]
SNX2 t(5;9)(q23.2;q34) SNX2::ABL1 on der(5) YES [14]
ZMIZ1 t(9;10)(q34;q22.3) ZMIZ1::ABL1 on der(10) YES [15]
ABL2

(1q25.2)

PAG1 t(1;8)(q25.2;q21.1) PAG1::ABL2 on der(1) YES [5]
RCSD1 1q24.2q25.2 rearrangement RCSD1::ABL2 NO [16] On the same chromosome arm; however, a simple deletion cannot cause the fusion due to the orientation of genes
ZC3HAV1 t(1;7)(q25.2;q34) ZC3HAV1::ABL2 on der(1) YES [17]
CRLF2

(Xp22.3 & Yp11.3)

IGH t(X;14)(p22.3;q32) or

t(Y;14)(p11.3;q32)

IGH::CRLF2 NO [18][5]
P2RY8 del(X)(p22.3p22.3) or del(Y)(p11.3p11.3) P2RY8::CRLF2 NO [18][5]
CSF1R

(5q32)

MEF2D t(1;5)(q22;q32) MEF2D::CSF1R on der(5) YES [19]
SSBP2 5q14.1q32 rearrangement SSBP2::CSF1R YES [7] On the same chromosome arm; however, a simple deletion cannot cause the fusion due to the orientation of genes
TBL1XR1 t(3;5)(q26.3;q32) TBL1XR1::CSF1R on der(5) YES [7]
DGKH (13q14.1) ZFAND3 t(6;13)(p21.2;q14.1) ZFAND3::DGKH YES [5] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
EPOR (19p13.2) IGH ins(14;19)(q32;p13.2p13.2) IGH/EPOR Cryptic insertion [20]
IGK ins(2;19)(p11.2;p13.2p13.2) IGK/EPOR Cryptic insertion [20]
LAIR1 inv(19)(p13.2q13.42) LAIR1::EPOR NO [20] Inversion of chromosome 19 juxtaposes EPOR to the upstream region of LAIR1
THADA t(2;19)(p21;p13.2) THADA::EPOR YES [13]
IL2RB (22q12.3) MYH9 22q12.3 rearrangement MYH9::IL2RB NO [5] On the same chromosome arm; however, a simple deletion cannot cause the fusion due to the orientation of genes
JAK2

(9p24.1)

ATF7IP t(9;12)(p24.1;p13.1) ATF7IP::JAK2 on der(9) NO [5][21]
BCR t(9;22)(p24.1;q11.2) BCR::JAK2 ? YES [22] Seen also in myeloproliferative neoplasms. Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
EBF1 t(5;9)(q33.3;p24.1) EBF1::JAK2 on der(9) NO (SUBTLE) [23]
ETV6 t(9;12)(p24.1;p13.2) ETV6::JAK2 on der(9) NO (SUBTLE) [24][25]
GOLGA5 t(9;14)(p24.1;q32.1) GOLGA5::JAK2 NO (SUBTLE) [26] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
HMBOX1 t(8;9)(p21.1;p24.1) HMBOX1::JAK2 on der(9) YES [27]
OFD1 t(X;9)(p22.2;p24.1) OFD1::JAK2 on der(9) NO (SUBTLE) [28]
PAX5 inv(9)(p13.2p24.1) PAX5::JAK2 YES [29] An inversion is required as genes are oriented in opposite directions
PCM1 t(8;9)(p22;p24.1) PCM1::JAK2 on der(9) YES (SUBTLE) [13] Seen also in myeloid/lymphoid neoplasms with eosinophilia
PPFIBP1 t(9;12)(p24.1;p11.2) PPFIBP1::JAK2 on der(9) YES [13]
RFX3 inv(9)(p24.1p24.2) RFX3::JAK2 NO [7] An inversion is required as genes are oriented in opposite directions
SMU1 inv(9)(p21.1p24.1) SMU1::JAK2 NO [27] An inversion is required as genes are oriented in opposite directions
SNX29 t(9;16)(p24.1;p13.1) SNX29::JAK2 on der(9) YES [27]
SPAG9 t(9;17)(p24.1;q21.3) SPAG9::JAK2 on der(9) YES [30]
SSBP2 t(5;9)(q14.1;p24.1) SSBP2::JAK2 on der(9) YES [31]
STRN3 t(9;14)(p24.1;q12) STRN3::JAK2 on der(9) YES [32]
TERF2 t(9;16)(p24.1;q22.1) TERF2::JAK2 on der(9) YES [33]
TPR t(1;9)(q31.1;p24.1) TPR::JAK2 on der(9) YES [5]
USP25 t(9;21)(p24.1;q21.1) USP25::JAK2 ? YES [7] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
ZBTB46 t(9;20)(p24.1;q13.3) ZBTB46::JAK2 on der(9) NO [13]
ZNF274 t(9;19)(p24.1;q13.4) ZNF274::JAK2 NO [7] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
ZNF340 t(9;20)(p24.1;q13.3) ZNF340::JAK2 on der(9) NO [13]
PDGFRA

(4q12)

FIP1L1 del(4)(q12q12) FIP1L1::PDGFRA NO [27] Interstitial deletion. Seen also in myeloid/lymphoid neoplasms with eosinophilia
PDGFRB (5q32) ATF7IP t(5;12)(q32;p13.1) ATF7IP::PDGFRB on der(5) YES [34][35][36]
EBF1 del(5)(q32q33.3) EBF1::PDGFRB NO [37] Interstitial deletion
ETV6 t(5;12)(q32;p13.2) ETV6::PDGFRB on der(5) YES [13]
SNX29 t(5;16)(q32;p13.1) SNX29::PDGFRB on der(5) YES [13]
SSBP2 t(5;5)(q14.1;q32) SSBP2::PDGFRB ? YES [13] On the same chromosome arm; however, a simple deletion cannot cause the fusion due to the orientation of genes
TNIP1 del(5)(q32q33.1) TNIP1::PDGFRB NO [13] Interstitial deletion. Seen also in myeloid/lymphoid neoplasms with eosinophilia
ZEB2 t(2;5)(q22.3;q32) ZEB2::PDGFRB on der(5) YES [5]
ZMYND8 t(5;20)(q32;q13.1) ZMYND8::PDGFRB on der(5) YES [7]
PTK2B (8p21.2) KDM6A t(X;8)(p11.3;p21.2) KDM6A::PTK2B on der(8) YES [5]
STAG2 t(X;8)(q25;p21.2) STAG2::PTK2B YES [5] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms
TMEM2 t(8;9)(p21.2;q21.1) TMEM2::PTK2B on der(8) YES [13]
TYK2 (19p13.2) MYB t(6;19)(q23.3;p13.2) MYB::TYK2 on der(6) YES [23]
SMARCA4 inv(19)(p13.2p13.2) SMARCA4::TYK2 NO [13]
ZNF340 t(19;20)(p13.2;q13.3) ZNF340::TYK2 NO [13] Requires complex rearrangement due to incompatible orientation of genes with respect to chromosome arms

Individual Region Genomic Gain/Loss/LOH

Chr # Gain, Loss, Amp, LOH Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size] Relevant Gene(s) Diagnostic, Prognostic, and Therapeutic Significance - D, P, T Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
5 Loss chr5:158,695,920-159,099,916

[GRCh38/hg38]

EBF1 Unknown No Deletion of EBF1 results in altered B-cell development.[38]
7 Loss chr7:50,303,455-50,405,101

[GRCh38/hg38]

IKZF1 P Yes, NCCN - Acute Lymphoblastic leukaemia Monoallelic (often partial) deletion of the IKAROS transcription factor, encoded by IKZF1, is one of the most frequently observed genetic abnormalities in B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features, although this finding is not specific and not included in the definition;[39] IKZF1 deletion is associated with poor prognosis.[40]
9 Loss chr9:21,967,752-21,995,324

chr9:22,002,903-22,009,313

[GRCh38/hg38]

CDKN2A

CDKN2B

Unknown No Deletion of CDKN2A/B results in altered B-cell development.[38]
9 Loss chr9:36,833,269-37,034,268

[GRCh38/hg38]

PAX5 Unknown No Deletion of PAX5 results in altered B-cell development.[38]
12 Loss chr12:11,649,674-11,895,377

[GRCh38/hg38]

ETV6 Unknown No Deletion of ETV6 results in altered B-cell development.[38]
13 Loss chr13:48,303,744-48,599,436

[GRCh38/hg38]

RB1 Unknown No Deletion of RB1 results in disrupted cell-cycle regulation.[38]
17 Loss chr17:7,661,779-7,687,546

[GRCh38/hg38]

TP53 Unknown No Deletion of TP53 results in in disrupted cell-cycle regulation.[38]

Characteristic Chromosomal or Other Global Mutational Patterns

Chromosomal Pattern Molecular Pathogenesis Prevalence -

Common >20%, Recurrent 5-20% or Rare <5% (Disease)

Diagnostic, Prognostic, and Therapeutic Significance - D, P, T Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
Chromosome X/Y cryptic deletion or translocation These changes cause CRLF2 overexpression, upregulating the JAK-STAT pathway. Common (>20%) P No Chromosome X/Y abnormalities include either translocation of the immunoglobin heavy chain enhance locus into CRLF2 (IGH::CRLF2—more commonly seen in adults) or a cryptic deletion involving the PAR1 psuedoautosomal region, resulting in fusion of CRLF2 and P2RY8 (more commonly seen in children); these alterations involving CRLF2 have been associated with poor survival;[41] very rare alternative translocations involving CRLF2 have also been observed.
Polysomy or iAMP21 These changes stem from telomere attrition that results in amplification of all or a region of chromosome 21. Rare (<5%) P No iAMP21 is considered high-risk cytogenetic abnormality/poor prognostic indicator, but it is not specific to B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features and can be seen in other B-lymphoblastic leukaemia/lymphomas.[42]


[Abnormal fluorescence in situ hybridization (FISH) results in interphase nuclei from a bone marrow sample using the CRLF2 dual-color, break-apart (Cytocell) and IGH dual-color, break-apart probes, reflective of IGH::CRLF2 rearrangement]


[Concurrent abnormal karyotype with trisomy 21 and a translocation involving chromosomes X, 14, and 2 in 9 of 13 cells available for analysis; metaphase FISH with the IGH break-apart probe (Vysis) confirms the presence of 5’ IGH (green signal) on the abnormal chromosome Xp33.1 (CRLF2 locus), highly suggestive on an IGH::CRLF2 fusion rearrangement: 47,XX,+21c[4]/47,idem,der(X)t(X;14)(p33.1;q32),der(2)t(2;14)(p11.2;q11.2)t(X;14),der(14)t(2;14)[5]/46,XX[4].ish der(X)(5’IGH+),der(2)(3’IGH+)]

(Images courtesy of Fabiola Quintero-Rivera, MD)

Gene Mutations (SNV/INDEL)

Gene Genetic Alteration Tumor Suppressor Gene, Oncogene, Other Prevalence -

Common >20%, Recurrent 5-20% or Rare <5% (Disease)

Diagnostic, Prognostic, and Therapeutic Significance - D, P, T   Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
CRLF2 p.F232C Oncogene Recurrent (5-20%) Unknown No p.F232C is a gain-of-function mutation that results in constitutive dimerization and cytokine independent growth within the JAK-STAT pathway.[43]
JAK1

JAK2

p.V658Fp.R683G Oncogene Recurrent (5-20%) Unknown No Half of cases with CRLF2 overexpression have activating mutations in JAK1 or JAK2 that promote downstream JAK-STAT signaling;[13] the most common mutation, p.R683G, occurs in the pseudokinase domain of JAK2, and less common JAK1 alterations have been detected, which include p.V658F most frequently; clinical trials examining the treatment effects of targeting JAK proteins are currently ongoing.[44]
IL7R Activating mutations Oncogene Recurrent (5-20%) Unknown No IL7R is the partner gene of CRLF2; gain-of-function mutations potentiate CRFL2 and its cofactor IL7RA forming a receptor for thymic stromal-derived lymphopoietin, leading to JAK-STAT activation.[45]
SH2B3

IL2RB TYK2 TLSP

Activating mutations Oncogene Recurrent (5-20%) Unknown No These result in constitutive activation of JAK-STAT signaling and are often present as multi-subclonal (suggestive of secondary driver events).[46]
RAS pathway genes Activating mutations Oncogenes Recurrent (5-20%) Unknown No Activating mutations in KRAS, NF1, PTPN11, and other genes upregulate the MAP kinase pathway and have been found at a higher frequency in B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features compared to other B-lymphoblastic leukaemia/lymphomas.[47]

Note: A more extensive list of mutations can be found in cBioportal, COSMIC, and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content

Epigenomic Alterations

Not applicable

Genes and Main Pathways Involved

Gene; Genetic Alteration Pathway Pathophysiologic Outcome
ABL-class rearrangements Tyrosine kinase signaling These result in B-cell progenitor proliferation; may be responsive to TKIs.[48]
CRLF2 overexpression; mutations of CRLF2, JAK1, IL7R, SH2B3, IL2RB, TYK2, and TLSP; JAK2 and EPOR rearrangements JAK-STAT signaling These potentiate the JAK2-signal transducer and upregulate the transcription 5 pathway;[45] other mutations not in CRLF2 and IL7R cause constitutive JAK/STAT activation downstream of CRLF2.
IKZF1 deletion IKAROS transcription factor signaling This results in activation of EBF1, MSH2, and MCL1, leading to B-cell leukemogenesis.[49]

Genetic Diagnostic Testing Methods

  • Flow cytometry for CRLF2 has been shown in some studies to be 100% concordant with FISH results[41].
  • Next-generation sequencing is helpful for detecting copy number changes, single nucleotide variants, and gene fusions involving CRLF2, ABL1, ABL2, JAK2, etc.
  • Gene expression profile algorithms, incorporating prediction analysis or hierarchical clustering of microarrays, provide a definitive diagnosis of B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features.

Familial Forms

Families with certain inherited variants of GATA3 (often seen in Native-American populations) are at increased risk of B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features.[50]

Additional Information

Clinical trial of TKI in B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features (Clinicaltrials.gov Identifier: NCT02883049)

Clinical trial of JAK inhibitor in B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features (Clinicaltrials.gov Identifier: NCT02723994)

Links

CRLF2

ABL1

ABL2

JAK2

PDGFRB

IKZF1

B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features in Pathology Outlines

References

(use the "Cite" icon at the top of the page) (Instructions: Add each reference into the text above by clicking where you want to insert the reference, selecting the “Cite” icon at the top of the wiki page, and using the “Automatic” tab option to search by PMID to select the reference to insert. If a PMID is not available, such as for a book, please use the “Cite” icon, select “Manual” and then “Basic Form”, and include the entire reference. To insert the same reference again later in the page, select the “Cite” icon and “Re-use” to find the reference; DO NOT insert the same reference twice using the “Automatic” tab as it will be treated as two separate references. The reference list in this section will be automatically generated and sorted.)

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Notes

*Primary authors will typically be those that initially create and complete the content of a page.  If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the Associate Editor or other CCGA representative.  When pages have a major update, the new author will be acknowledged at the beginning of the page, and those who contributed previously will be acknowledged below as a prior author.

Prior Author(s): Fabiola Quintero-Rivera, MD

*Citation of this Page: “B-lymphoblastic leukaemia/lymphoma with BCR::ABL1-like features”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated 11/5/2025, https://ccga.io/index.php/HAEM5:B-lymphoblastic_leukaemia/lymphoma_with_BCR::ABL1-like_features.