title: High-Risk Microgranular Acute Promyelocytic Leukemia with a Five-Way Complex Translocation Involving PML-RARA.
abstract: Acute promyelocytic leukemia (APL) is classically characterized by chromosomal translocation (15;17), resulting in the PML-RARA fusion protein leading to disease. Here, we present a case of a 50-year-old man who presented with signs and symptoms of acute leukemia with concern for APL. Therapy was immediately initiated with all-trans retinoic acid. The morphology of his leukemic blasts was consistent with the hypogranular variant of APL. Subsequent FISH and cytogenetic analysis revealed a unique translocation involving five chromosomal regions: 9q34, 17q21, 15q24, 12q13, and 15q26.1. Molecular testing demonstrated PML/RARA fusion transcripts. Treatment with conventional chemotherapy was added and he went into a complete remission. Given his elevated white blood cell count at presentation, intrathecal chemotherapy for central nervous system prophylaxis was also given. The patient remains on maintenance therapy and remains in remission. This is the first such report of a 5-way chromosomal translocation leading to APL. Similar to APL with chromosomal translocations other than classical t(15;17) which result in the typical PML-RARA fusion, our patient responded promptly to an ATRA-containing regimen and remains in complete remission.
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66210, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Powers
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66210, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Persons
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66210, USA.
authors.forename: Deepthi
authors.initials: D
authors.lastname: Rao
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66210, USA.
authors.forename: Janet
authors.identifier: 0000-0002-0949-2836
authors.initials: J
authors.lastname: Woodroof
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66210, USA.
authors.forename: Tara L
authors.initials: TL
authors.lastname: Lin