title: Therapy-related B-lymphoblastic leukemia associated with Philadelphia chromosome and MLL rearrangement: Single institution experience and the review of the literature.
abstract: Therapy related acute lymphoblastic leukemia (t-ALL) of B cell origin is rare and constitutes approximately 2% of all ALL. Previously compiled data on the complete cytogenetic analysis of 48 t-B-ALL cases suggested that MLL rearrangement at 11q23 gene locus is the most common abnormality. Philadelphia chromosome (Ph) and a normal karyotype were reported as the second and third most common karyotypes, respectively. We investigated cytogenetic karyotypes of six t-B-ALL cases with a pre-B cell immunophenotype. Ph + t-B-ALL was noted in four of six patients previously treated with radiation and/or chemotherapy. In addition, one case demonstrated MLL rearrangement at 11q23 locus while one case demonstrated normal cytogenetic karyotype. Five of the six t-B-ALL patients had persistent leukemia following initiation of chemotherapy for secondary leukemia with survival ranging from 10 to 21 months. To our knowledge, only fourteen patients with Ph + t-B-ALL have been described in the literature. In the current study, three of four cases with Ph + t-B-ALL were associated with treated breast carcinoma while one patient was treated for Hodgkin lymphoma. All four patients had undergone radiation therapy. The results may indicate a plausible association between Ph+t-B-ALL and prior radiation exposure.
authors.affiliation: Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Matnani
authors.affiliation: Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Vishwas
authors.initials: V
authors.lastname: Parekh
authors.affiliation: Department of Medicine, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Borate
authors.affiliation: Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Brazelton
authors.affiliation: Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Department of Pathology, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Deniz
authors.initials: D
authors.lastname: Peker
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics; D002880:Chromosomes, Human, Pair 11 / Q000235:genetics; D020732:Cytogenetic Analysis / Q000379:methods; D005260:Female; D015321:Gene Rearrangement / Q000235:genetics*; D011495:Histone-Lysine N-Methyltransferase / Q000235:genetics*; D006801:Humans; D016130:Immunophenotyping / Q000379:methods; D007621:Karyotyping; D008297:Male; D008875:Middle Aged; D051788:Myeloid-Lymphoid Leukemia Protein / Q000235:genetics*; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000235:genetics / Q000473:pathology*; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics*; D014178:Translocation, Genetic / Q000235:genetics
chemical_list: C497422:KMT2A protein, human; D051788:Myeloid-Lymphoid Leukemia Protein; D011495:Histone-Lysine N-Methyltransferase
keywords: B-ALL; MLL; Philadelphia chromosome; therapy-related