Cytogenetic abnormalities in acute lymphoblastic leukemia

Acute lymphoblastic leukemias (ALL) represent malignant clonal proliferations of stem cells committed in lymphoid differentiation, B or T-cell ALL. Clonal chromosomal abnormalities are found in 80% children and 70% adult cases. They are associated with an independent prognostic value which modifies the therapeutic approach and therefore karyotyping at diagnosis is mandatory. Molecular techniques such as FISH and RT-PCR are very helpful too as cryptic chromosomal abnormalities have been described. In this review, numerical and structural abnormalities are described: frequency, diagnosis and prognosis value as well as genes involved in structural abnormalities.     

Cytogenetic findings in childhood acute lymphoblastic leukemia

Chromosome studies were performed on the bone marrow cells of 42 children with newly diagnosed acute lymphoblastic leukemia (ALL). All the children were subsequently treated with the same protocol. Chromosomal abnormalities were found in 25 patients, i.e., in 59.5% of the cases. Hyperdiploidy was observed in 21.4% hypodiploidy in 14.3%, and pseudodiploidy in 23.8% of the children. The most frequent structural aberrations were translocations, which were found in half of the patients with abnormal karyotypes. Chromosomes #5, #6, #7, #9, #14, #17, and #21 were involved in different types of changes most frequently. Because these findings correspond with observations published by others, they can be regarded as evidence of nonrandom involvement of these chromosomes in rearrangements in ALL. Special attention should be also paid to the deletion of 6q, which seems to be relatively common in ALL. In 12 cases, clonal evolution of karyotypic changes was observed.     

1058例急性非淋巴细胞白血病的细胞遗传学分析

目的：评估我国大系列急性非淋巴细胞白血病（acute nonlymphocytic leukemia,ANLL)的核型状况。方法：采用直接法和短期培养法制备骨髓细胞染色体,并以R显带为主、G显带为辅对1058例初治的ANLL患者进行染色体核型分析。结果：本组中630例（60％）有克隆性染色体异常。主要异常核型共有25种,其中11种为特异性染色体重排,见于481例,占核型异常患者总数的76％。单纯＋8（21例）为常见的数目异常。t(15;17)(211例）和t（8;21）（200例）为最常见的结构异常。1．1％的M2、72％的M3、71％的M4EO、50％的M2、6％的M5和1．4％的M2分别有t（7;11）、t(15;17)、inv(16)、t(8;21)、t/del(11q23)和t/del(12p)异常,而100％的t(7;11)、100%的t（15;17）、100％的inv(16)、88．5％的t(8;21）、83％的t/del(11q23)和62％的t/del（12p)分别见于M2、M3、M4E0、M2、M5和M2亚型患者。结论：联合应用R带和G带两种常规显带技术,60％的ANLL患者可检出克隆性染色体异常且主要为特异性染色体重排。它们和特定的FAB亚型相关,因而核型是ANLL诊断和分型的一项重要指标。     

Paediatric x-ray examinations in Rio de Janeiro

This work presents the results of a dose survey performed for paediatric patients and carried out in two large paediatric public hospitals in Rio de Janeiro city. The entrance surface dose (ESD) and the effective dose (ED) were evaluated for chest, skull, abdomen, lumbar spine, cervical spine and pelvis in antero-posterior (AP), postero-anterior (PA) and lateral (LAT) projections. For each examination, four age groups 0-1, 1-5, 5-10 and 10-15 years were studied. The DoseCal software was used to calculate these doses. Wide variations for the same type of examination and projection have been detected. These variations were evident, in Brazil, from previous work. In spite of the present results being still preliminary, they can give an idea of what paediatric ESDs are like in Brazil. Also, with respect to the entrance surface dose, some of the results are above the reference levels, which cause high ED, as well. On the other hand, the wide range of ESD reflects the disparity of radiographic techniques and demonstrates that the ALARA principle is not being applied in Brazilian hospitals and becomes a concern in terms of public health.     

Cytogenetic studies of 21 patients with acute lymphoblastic leukemia in relapse

Karyotypes of 21 patients, originally entered into the Third International Workshop on Chromosomes in Leukemia (3IWCL), were investigated in first, second and/or subsequent relapses. Karyotypes at diagnosis were related to the relapses in the following ways: normal to normal (N-N) (five cases); abnormal to normal (A-N) (two cases); abnormal to abnormal with no change (A-A) (five cases); abnormal to abnormal with clonal evolution (A-A+) (eight cases); and normal to abnormal (N-A) (one case). The A-A group comprised two each of t(4;11) and t(9;22) cases and one pseudodiploid case; included in this group were the only two patients who did not receive intensive treatment. Both A-N cases had been pseudodiploid at diagnosis. Clonal evolution A-A+ occurred in patients who had had 47–49 chromosomes or pseudodiploidy at diagnosis and was mainly due to the addition of structural change. The additional abnormalities were different in each case. The only de novo appearance of a clone (N-A) was in host cells in relapse following bone marrow transplantation. Clonal evolution occurred in patients who had been intensively treated and who relapsed late; the median time from diagnosis to relapse studied for the A-A group was 6 months and for the A-A+ group was 24 months. Survival following relapse was shorter for patients who had had a clonal abnormality at any time (median 10 months) than for those with no abnormality at diagnosis or in relapse (median 26 months).     

Cytogenetic studies on 519 consecutive de novo acute nonlymphocytic leukemias

Cytogenetic studies were performed in the same laboratory on 519 untreated cases of de novo acute nonlymphocytic leukemia (ANLL) between 1977 and 1985. The overall incidence of clonal chromosome abnormalities was 54.3%; higher in children (67.5%) than in adults (50.4%). The distribution of chromosome abnormalities was uneven, according to the categories of the FAB nomenclature. The highest frequency of chromosome changes was observed in ANLL-M3 and the lowest in M1 and M6. The frequency of specific chromosome abnormalities and of their associated changes were also estimated. Monosomy 7 was detected in three patients with acute megakaryocytic leukemia (M7). Six cases with two abnormal chromosomally unrelated clones were observed and six constitutional chromosome abnormalities were detected. A clearer knowledge of the incidence of various chromosomal changes in ANLL seems necessary for better differentiation between the so-called primary and secondary chromosome abnormalities and for prognostic evaluation.     

Adenoviruses in faeces of children with acute gastroenteritis in Rio de Janeiro, Brazil

Faeces from 746 children less than 5 years old with acute gastroenteritis were screened for the presence of adenovirus particles or antigens by immunoelectron microscopy (IEM) and enzyme immunoassay (EIA). Thirty-five samples were positive by both IEM and EIA, two only by IEM, and two only by EIA, giving a total of 39 (5.2%) samples with positive results. Of these, 25 could be propagated in HEp2 cells and were neutralized by one of the antisera to adenovirus types 1 to 18. The remaining 14 samples could be propagated only in the 293 permanent line of human cells transformed by adenovirus type 5 DNA [Graham et al, 1977] and were not neutralized by antisera to adenovirus types 1 to 31. An EIA carried out by the antibody-capture technique, using antiserum specific for "enteric" adenoviruses [Johansson et al, 1979], gave positive results with all isolates that could be propagated only in 293 cells and with none of those capable of growing in HEp2 cells.     

Y-chromosome genetic variation in Rio de Janeiro population.

The present-day Brazilian gene pool is known to be the outcome of an admixture process of populations from different origins, mainly Amerindians, Europeans, and Africans. It is also known that in Brazil, a wide variation in the admixture process occurred in different regions of the country or even in different subpopulations from the same region. In the present study, we aimed to characterize the male lineages present in the Rio de Janeiro population, the second most populated of the 26 Brazilian states. A random sample of 127 unrelated males from Rio de Janeiro was typed for 28 Y-chromosome-specific biallelic markers. In total, 17 different haplogroups were defined within our sample, most of them of European ancestry (88.1%). Those of sub-Saharan African origin (E3a) amounted to 7.9%, while only 2 males carried Amerindian lineages (characterized by the presence of an M3 mutation: haplogroup Q3). Using both Y-STR haplotype and Y-SNP haplogroup information, genetic distances were calculated between the subgroup of Rio de Janeiro males carrying European haplogroups and the Portuguese population. Low, nonsignificant, values were obtained. Thus, in contrast with what is observed in their female counterparts, the vast majority of the present Rio de Janeiro male gene pool is of European extraction, while the original Amerindian lineages are residual and much less frequent than the sub-Saharan component resulting from the slave trade. These observations can be interpreted as the signature of the strong gender asymmetry of the admixture processes in colonial systems.     

The genomic analysis of rubella virus detected from outbreak and sporadic cases in Rio de Janeiro state, Brazil.

BACKGROUND: The molecular epidemiology of rubella virus (RV) based on the analysis of the viral E1 gene sequences indicated the existence of two genotypes that differ from each other by 8 to 10% in their nucleotide sequences: genotype I is present in Europe, North America and Asia; and genotype II is present only in Asia. OBJECTIVES: The purpose of the study was to identify the RV genotypes circulating in Brazil. STUDY DESIGN: In this study, we analysed 86 clinical samples collected between 1996 and 1999 during a rubella outbreak and from sporadic cases of rubella in Rio de Janeiro State. For the molecular characterisation of RV strains we have used PCR/nested amplification and direct sequencing of a 513-nucleotide region of the E1 gene. RESULTS: The E1 gene sequences of 14 RVs were obtained and were assigned to two lineages, both within genotype I. The percentage divergence of nucleotide sequence ranged from 3.4 to 5.1% between these two lineages. These results were in agreement with the pattern of variation observed among the sequences obtained from other lineages of RV. CONCLUSIONS: This work demonstrated that two new lineages of RV circulated simultaneously between the years 1996 and 1999 in the state of Rio de Janeiro. These results provided new approaches for monitoring the progress of vaccination efforts in Brazil.     

Cytogenetic analysis of adult acute lymphoblastic leukemia including a Ph+ case surviving more than 5 years

We have performed cytogenetic analysis on 25 consecutive adult patients with previously untreated acute lymphoblastic leukemia (ALL) who were subsequently treated with the same protocol at this institution. Ten of the 25 patients studied (40%) demonstrated karyotypic abnormalities. The most frequent abnormalities were hyperdiploidy (six patients) and presence of the Philadelphia (Ph) chromosome (three patients). Univariate analysis of 12 features identified only immunophenotype as differing between patients with abnormal and normal karyotype. The cells of patients with an abnormal karyotype were more often non-B, non-T and less often T cell in phenotype. One patient initially with Ph remains cytogenetically normal in complete remission 272 weeks post diagnosis. We confirm that cytogenetic abnormalities are frequent in adult ALL. The attainment of disease free survival in Ph-positive ALL of more than 5 years with persistently normal cytogenetics demonstrates that aggressive multimodal therapy can induce long-term remissions and possible cure of this usually unfavorable situation.     

Cytogenetic analysis in children with acute nonlymphocytic leukemia.

In this work we present the results of cytogenetic analysis of the malignant cells in 27 children with acute nonlymphocytic leukemia (ANLL). The aim of our investigations was to determine the frequency and types of chromosome aberrations in our population of children with ANLL. Successful cytogenetic analysis was carried out in 24 (89%) patients. Aberrant karyotypes of malignant cells were established in 58% of the cases. The most frequent chromosomal abnormality was t(8;21), identified in 5 (20.8%) patients, i.e., 4 of 10 M2-ANLL. Aberration frequency of chromosome 11 was 16.6% and was identified in 3 of 8 M5-ANLL. Trisomy 8 and monosomy 7 were identified in one patient each with M3 and M2-ANLL, respectively. del(13), a rare chromosome aberration in hemoblastoses, was found in a child with M1,t(8;21) and the loss of chromosome Y. Translocation t(1;11;21) with a break in regions 1q23, 11q23, and 21q22, is unusual and was identified in a boy with M2-ANLL; it can be considered as a variant form of the t(8;21).     

Two cases of acute lymphoblastic leukemia with cytoplasmic granules

The presence of cytoplasmic granules in blastoid cells of patients with acute leukemia is generally accepted as a useful morphological marker for differentiation of myeloid leukemia from lymphoblastic leukemia. We diagnosed two cases of acute lymphoblastic leukemia(ALL) with cytoplasmic granulation. Surface marker analysis of leukemic cells revealed they were positive for CD10, 19, 20, 33, 34 and HLA-DR. Immunoglobulin gene rearrangement was detected by means of Southern hybridization with an Ig-JH probe for both patients. On the basis of these findings, the patients were diagnosed as having B-precursor ALL. Electron microscopic observation showed no myeloperoxidase activity, so that the granules were considered to be related to autophagolysosomes. This experience demonstrates that the recognition of the presence of granular ALL is necessary for making an accurate differential diagnosis of acute leukemias.     

浆膜腔积液淋巴母细胞淋巴瘤/急性淋巴细胞白血病的细胞学诊断分析

目的探讨浆膜腔积液淋巴母细胞淋巴瘤/急性淋巴细胞白血病(LBL/ALL)的细胞病理学诊断线索及意义。方法收集郑州大学第一附属医院2011年8月至2019年12月确诊为LBL/ALL的浆膜腔积液标本45例,观察并总结其临床特点及细胞形态学特征,其中22例标本被制成细胞块并行免疫细胞化学检测,3例行流式细胞术检测,5例行T细胞受体(TCR)和免疫球蛋白(Ig)基因重排分析。结果45例病例中男性35例,女性10例,男女比为3.5∶1.0,中位年龄15岁。39例(86.7%)患者有纵隔肿块,34例(75.6%)患者伴有血清乳酸脱氢酶(LDH)的增高;显微镜下,细胞量较为丰富,弥漫散在分布;细胞成分相对单一,小至中等大小;细胞核形不规则或曲核,可见核裂或乳头状突起,染色质细,核仁不明显;核分裂象易见;胞质少或无,背景均可见到核碎裂及凋亡小体。22例细胞块免疫表型为19例(86.4%)表达末端脱氧核苷酸转移酶(TdT),20例(90.9%)表达CD99,Ki-67阳性指数65%~95%。行流式细胞术检测的3例标本均显示TdT、CD2、CD3和CD7高表达的异常T细胞,行基因重排检测的5例标本中,4例呈TCR单克隆重排,1例同时发现TCR和Igκ单克隆重排。结论结合临床特征(青少年男性伴有纵隔肿块)和细胞形态特点(大量散在分布的形态单一的中小淋巴细胞,明显的核形不规则,染色质细腻,易见核分裂象、核碎裂及凋亡小体),可以对浆膜腔积液LBL/ALL进行初步诊断,辅以免疫细胞化学结果及其他辅助检测技术可进一步提高LBL/ALL诊断的准确性和可靠性。     

Cytogenetic study in a mentally retarded child with bloom syndrome and acute lymphoblastic leukemia

Bloom syndrome (BS) was diagnosed in a 7-year-old boy during hospitalization for acute lymphoblastic leukemia (ALL). The patient had most of the signs of BS along with some atypical manifestations: absence of telangiectases, obesity, and moderate mental retardation. Results of the cytogenetic studies were fully consistent with the diagnosis of BS: the occurrence of quadriradial figures and a very high incidence of sister-chromatid exchanges (SCE). This child's ALL was of non-B, non-T type with the presence, at the time of diagnosis, of a marrow clone including two markers. A Yq– chromosome was detected in about 10% of PHA-stimulated lymphocytes but neither in bone marrow cells nor in skin fibroblasts. This case is the fifth instance of ALL out of 104 registered cases of BS.     

初发急性髓性白血病患者外周血中高表达TAL1基因及其意义

目的:分析调控造血分化的重要转录因子TAL1在急性髓性白血病(AML)细胞株及原代AML细胞中的表达特点。方法:利用real-time PCR法分别检测47例初发急性髓性白血病患者外周血单个核细胞以及急性白血病细胞株(Jurkat、CCRF-CEM、HL-60和NB4细胞株)中TAL1 mRNA的水平,并以12例健康志愿者外周血样本作为对照组。结果:TAL1 mRNA在AML细胞株(HL-60和NB4)、T细胞急性淋巴细胞白血病(T-ALL)细胞株(Jurkat和CCRF-CEM)和原代AML细胞中的水平均显著高于健康对照组(P0.05)。各AML亚型中TAL1的mRNA表达水平均较对照组显著升高,并以AML-M1和AML-M5 2个亚型升高最为明显(P0.05)。结论:AML细胞中TAL1异常高表达可能与其影响粒系的分化发育有关,其能否作为AML发病相关分子标志物有待进一步研究。