title: Myelodysplastic syndromes arising in patients with germline TP53 mutation and Li-Fraumeni syndrome.
abstract: BACKGROUND
  Li-Fraumeni syndrome (LFS), characterized by predisposition to early onset of a variety of malignancies, is usually associated with germline mutation of the tumor-suppressor gene, TP53. Mutation carriers are at increased risk of multiple primary tumors, many of which arise in previous radiation-therapy sites. In patients with LFS, acute myeloid leukemia is uncommon and myelodysplastic syndrome (MDS) is rare.
  
  
  OBJECTIVE
  To evaluate the morphologic, cytogenetic, and molecular diagnostic findings of 3 unique cases of MDS arising in patients with germline TP53 mutation, 2 with classic LFS.
  
  
  METHODS
  We searched the Li-Fraumeni Syndrome Registry in the Department of Genetics at the University of Texas M. D. Anderson Cancer Center (Houston, Texas) and identified 3 patients with documented germline TP53 mutations or LFS who had developed MDS during a period of 6 years (2000-2005). The clinical, cytogenetic, and molecular diagnostic data and bone marrow aspirate smears and biopsies on all patients were reviewed. Immunohistochemical staining with antibody to p53 was also performed.
  
  
  RESULTS
  Two patients met the criteria for classic LFS; one had no history of malignancy in first-degree relatives. The MDS followed chemotherapy and radiation therapy and progressed to acute myeloid leukemia in 2 patients. Cytogenetic analysis demonstrated chromosome 5 abnormalities in a complex karyotype in all cases. Two patients died, one of acute myeloid leukemia and one with glioblastoma multiforme, MDS, and persistent pancytopenia.
  
  
  CONCLUSIONS
  Patients with LFS may develop MDS, which is most likely therapy-related and is associated with cytogenetic markers of poor prognosis.
authors.affiliation: Department of Hematopathology,University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
authors.forename: Sameer S
authors.initials: SS
authors.lastname: Talwalkar
authors.forename: C Cameron
authors.initials: CC
authors.lastname: Yin
authors.forename: Rizwan C
authors.initials: RC
authors.lastname: Naeem
authors.forename: M John
authors.initials: MJ
authors.lastname: Hicks
authors.forename: Louise C
authors.initials: LC
authors.lastname: Strong
authors.forename: Lynne V
authors.initials: LV
authors.lastname: Abruzzo
mesh_terms: D002648:Child; D002869:Chromosome Aberrations; D002895:Chromosomes, Human, Pair 5; D020732:Cytogenetic Analysis; D017809:Fatal Outcome; D005260:Female; D016158:Genes, p53; D018095:Germ-Line Mutation; D005909:Glioblastoma / Q000150:complications; D006801:Humans; D007223:Infant; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000209:etiology; D016864:Li-Fraumeni Syndrome / Q000150:complications* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000235:genetics*; D010198:Pancytopenia / Q000150:complications