title: Sometimes it is better to wait: First Italian case of a newborn with transient abnormal myelopoiesis and a favorable prognosis.
abstract: Congenital leukemia is rare disease with an incidence of one to five cases per million births. Transient abnormal myelopoiesis (TAM), also called transient myeloproliferative disorder, is a pre-leukemia disorder that may occur in Down syndrome (DS) or non-DS infants. TAM may enter spontaneous remission; however, continual monitoring is required, as this disorder has been observed to develop into acute megakaryoblastic leukemia in 16-30% of cases. In the literature, 16 cases of TAM in non-DS infants have been reported. The case presented in the current study is, to the best of our knowledge, the first case of an Italian non-DS newborn presenting with clinical manifestations of acute leukemia at five days after birth, exhibiting a normal karyotype, trisomy 21 only in blast cells, and spontaneous remission. Chromosomal analyses on peripheral blood cells, bone marrow cells and dermal fibroblasts were conducted using a G-banding technique, and fluorescencein situhybridization (FISH) was used to identify the critical regions of DS. Amplification of GATA binding protein 1 (GATA1) exon 2 genomic DNA was performed using polymerase chain reaction. Cytogenetic analysis of 50 peripheral blood cells and dermal fibroblasts from the patient revealed a normal karyotype: 46, XX. Conversely, cytogenetic analysis of the patient's bone marrow revealed an abnormal karyotype 47, XX+21. In order to investigate this result, FISH was performed, which identified the presence of three signals in 70% of the cells and two signals in 30% of bone marrow cells.GATA1sequencing revealed the substitution of a single base (c.150delG) in exon 2. Seven months after the initial analysis, FISH and cytogenetic analyses of the stimulated/unstimulated peripheral blood cells and bone marrow cells were performed, revealing that each exhibited diploid signals, as observed in a normal karyotype.
authors.affiliation: Department of Neonatology, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Salvatori
authors.affiliation: Department of Neonatology, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Foligno
authors.affiliation: Department of Genetic Laboratories, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Sirleto
authors.affiliation: Department of Genetic Laboratories, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Genovese
authors.affiliation: Department of Genetic Laboratories, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Russo
authors.affiliation: Department of Hematology, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Coletti
authors.affiliation: Department of Neonatology, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dotta
authors.affiliation: Department of Hematology, Bambino Gesù Children's Hospital, I-00165 Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Luciani
keywords: Down syndrome; acute megakaryoblastic leukemia; transient abnormal myelopoiesis; transient myeloproliferative disorder