title: Atypical t(15;17)(q13;q12) in a patient with all-trans retinoic acid refractory secondary acute promyelocytic leukemia: a case report and review of the literature.
abstract: A 69-year-old woman developed microgranular acute promyelocytic leukemia (APL-M3) 10 months after receiving adjuvant cyclophosphamide, doxorubicin, and paclitaxel for breast cancer. Replicate bone marrow aspirate karyotypes contained a translocation between the long arms of chromosomes 15 and 17, but not at breakpoints typical for APL. Fluorescence in situ hybridization paints and RARalpha/PML cosmid probes verified that the breakpoints on chromosomes 15 and 17 were proximal to both the PML and RARalpha genes; t(15;17)(q13;12). Although the patient received induction chemotherapy and a several month trial of all-trans retinoic acid (ATRA), there was no clinical improvement or hematological remission. We suspect that this patient developed postchemotherapy secondary APL with an atypical t(15;17), which rendered her leukemic cells unresponsive to ATRA therapy.
authors.affiliation: Department of Medicine, West Virginia University, Morgantown, WV 26506, USA.
authors.forename: Sobha
authors.initials: S
authors.lastname: Kurian
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hogan
authors.forename: Ona C
authors.initials: OC
authors.lastname: Bleigh
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: Dowdy
authors.forename: Taha
authors.initials: T
authors.lastname: Merghoub
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Pandolfi
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Wenger
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy / Q000235:genetics; D019457:Chromosome Breakage / Q000235:genetics; D002884:Chromosomes, Human, Pair 15 / Q000235:genetics*; D002886:Chromosomes, Human, Pair 17 / Q000235:genetics*; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000188:drug therapy / Q000235:genetics*; D018168:Receptors, Retinoic Acid / Q000235:genetics / Q000378:metabolism; D000072482:Retinoic Acid Receptor alpha; D014178:Translocation, Genetic / Q000235:genetics*; D014212:Tretinoin / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: C000607071:RARA protein, human; D018168:Receptors, Retinoic Acid; D000072482:Retinoic Acid Receptor alpha; D014212:Tretinoin