Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Spotlight
  • Published:

Spotlight on Acute Promyelocytic Leukemia

Variations on a theme: the alternate translocations in APL

Abstract

The t(15;17)(q22;q21) translocation is tightly linked to the APL phenotype, and the resultant PML-RAR fusion can be demonstrated in 98% of APL cases. Rare variant translocations have been reported, the majority of which on detailed analysis represent cryptic PML-RAR fusions. However, a handful of APL cases have been described with different genotypes. These include the t(11;17)(q23;q21) that produces the PLZF-RAR fusion, t(5;17)(q35;q21) that forms NPM-RAR, t(11;17)(q13;q21) that generates NUMA-RAR, and der(17) that creates STAT5b-RAR. In this review we will discuss these variant translocations, and discuss the insights that we have gained from their study.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Grimwade D, Biondi A, Mozziconacci MJ, Hagemeijer A, Berger R, Neat M, Howe K, Dastugue N, Jansen J, Radford-Weiss I, Lo Coco F, Lessard M, Hernandez JM, Delabesse E, Head D, Liso V, Sainty D, Flandrin G, Solomon E, Birg F, Lafage-Pochitaloff M . Characterization of acute promyelocytic leukemia cases lacking the classic t(15;17): results of the European Working Party. Groupe Français de Cytogénétique Hematologique, Groupe de Français d'Hematologie Cellulaire, UK Cancer Cytogenetics Group and BIOMED 1 European Community-Concerted Action ‘Molecular Cytogenetic Diagnosis in Haematological Malignancies’ Blood 2000 96: 1297–1308

    CAS  PubMed  Google Scholar 

  2. de Thé H, Lavau C, Marchio A, Chomienne C, Degos L, Dejean A . The PML-RAR alpha fusion mRNA generated by the t(15;17) translocation in acute promyelocytic leukemia encodes a functionally altered RAR Cell 1991 66: 675–684

    Article  PubMed  Google Scholar 

  3. Kakizuka A, Miller WJ, Umesono K, Warrell RJ, Frankel SR, Murty VV, Dmitrovsky E, Evans RM . Chromosomal translocation t(15;17) in human acute promyelocytic leukemia fuses RAR alpha with a novel putative transcription factor, PML Cell 1991 66: 663–674

    CAS  PubMed  Google Scholar 

  4. Grimwade D, Gorman P, Duprez E, Howe K, Langabeer S, Oliver F, Walker H, Culligan D, Waters J, Pomfret M, Goldstone A, Burnett A, Freemont P, Sheer D, Solomon E . Characterization of cryptic rearrangements and variant translocations in acute promyelocytic leukemia Blood 1997 90: 4876–4885

    CAS  PubMed  Google Scholar 

  5. Chen Z, Brand NJ, Chen A, Chen SJ, Tong JH, Wang ZY, Waxman S, Zelent A . Fusion between a novel Kruppel-like zinc finger gene and the retinoic acid receptor-alpha locus due to a variant t(11;17) translocation associated with acute promyelocytic leukaemia Embo J 1993 12: 1161–1167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Chen Z, Guidez F, Rousselot P, Agadir A, Chen SJ, Wang ZY, Degos L, Zelent A, Waxman S, Chomienne C . PLZF-RAR alpha fusion proteins generated from the variant t(11;17)(q23;q21) translocation in acute promyelocytic leukemia inhibit ligand-dependent transactivation of wild-type retinoic acid receptors Proc Natl Acad Sci USA 1994 91: 1178–1182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. de The H, Chomienne C, Lanotte M, Degos L, Dejean A . The t(15;17) translocation of acute promyelocytic leukaemia fuses the retinoic acid receptor alpha gene to a novel transcribed locus Nature 1990 347: 558–561

    Article  CAS  PubMed  Google Scholar 

  8. Evans R . The steroid and thyroid hormone receptor superfamily Nature 1988 240: 889–895

    CAS  Google Scholar 

  9. Licht JD, Chomienne C, Goy A, Chen A, Scott AA, Head DR, Michaux JL, Wu Y, DeBlasio A, Miller WH Jr . Clinical and molecular characterization of a rare syndrome of acute promyelocytic leukemia associated with translocation (11;17) Blood 1995 85: 1083–1094

    CAS  PubMed  Google Scholar 

  10. Jansen JH, Lowenberg B . Acute promyelocytic leukemia with a PLZF-RARalpha fusion protein Semin Hematol 2001 38: 37–41

    Article  CAS  PubMed  Google Scholar 

  11. Corey SJ, Locker J, Oliveri DR, Shekhtar-Levin S, Redner RL, Penchansky L, Gollin SM . A non-classical translocation involving 17q12 (retinoic acid receptor alpha) in acute promyelocytic leukemia with atypical features Leukemia 1994 8: 1350–1353

    CAS  PubMed  Google Scholar 

  12. Redner RL, Rush EA, Faas S, Rudert WA, Corey SJ . The t(5;17) variant of acute promyelocytic leukemia expresses a nucleophosmin-retinoic acid receptor fusion Blood 1996 87: 882–886

    CAS  PubMed  Google Scholar 

  13. Okuda M, Horn HF, Tarapore P, Tokuyama Y, Smulian AG, Chan PK, Knudsen ES, Hofmann IA, Snyder JD, Bove KE, Fukasawa K . Nucleophosmin/B23 is a target of CDK2/cyclin E in centrosome duplication Cell 2000 103: 127–140

    Article  CAS  PubMed  Google Scholar 

  14. Hummel JL, Wells RA, Dube ID, Licht JD, Kamel-Reid S . Deregulation of NPM and PLZF in a variant t(5;17) case of acute promyelocytic leukemia Oncogene 1999 18: 633–641

    Article  CAS  PubMed  Google Scholar 

  15. Xu L, Zhao WL, Xiong SM, Su XY, Zhao M, Wang C, Gao YR, Niu C, Cao Q, Gu BW, Zhu YM, Gu J, Hu J, Yan H, Shen ZX, Chen Z, Chen SJ . Molecular cytogenetic characterization and clinical relevance of additional, complex and/or variant chromosome abnormalities in acute promyelocytic leukemia Leukemia 2001 15: 1359–1368

    Article  CAS  PubMed  Google Scholar 

  16. Morris SW, Kirstein MN, Valentine MB, Dittmer KG, Shapiro DN, Saltman DL, Look AT . Fusion of a kinase gene, ALK, to a nuclear protein gene, NPM, in non-Hodgkin's lymphoma Science 1994 263: 1281–1284

    Article  CAS  PubMed  Google Scholar 

  17. Redner RL, Corey SJ, Rush EA . Differentiation of t(5;17) variant acute promyelocytic leukemic blasts by all-trans retinoic acid Leukemia 1997 11: 1014–1016

    Article  CAS  PubMed  Google Scholar 

  18. Wells RA, Catzavelos C, Kamel-Reid S . Fusion of retinoic acid receptor alpha to NuMA, the nuclear mitotic apparatus protein, by a variant translocation in acute promyelocytic leukaemia Nat Genet 1997 17: 109–113

    Article  CAS  PubMed  Google Scholar 

  19. Arnould C, Philippe C, Bourdon V, Gregoire MJ, Berger R, Jonveaux P . The signal transducer and activator of transcription STAT5b gene is a new partner of retinoic acid receptor alpha in acute promyelocytic-like leukaemia Hum Mol Genet 1999 8: 1741–1749

    Article  CAS  PubMed  Google Scholar 

  20. Cigudosa JC, Calasanz MJ, Odero MD, Marin J, Bengoechea E, Gullon A . A variant t(14;17) in acute promyelocytic leukemia. Positive response to retinoic acid treatment Cancer Genet Cytogenet 1995 80: 160–161

    Article  CAS  PubMed  Google Scholar 

  21. Miura I, Nishinari T, Hashimoto K, Nimura T, Miura S, Miura AB . Translocation (8;17)(p21;q21), a possible variant of t(15;17), in acute promyelocytic leukemia Cancer Genet Cytogenet 1994 72: 75–77

    Article  CAS  PubMed  Google Scholar 

  22. Schwartz JG, Clare N, Hansen K, Britton H, Manhoff L . Acute promyelocytic leukemia: report of a variant translocation, t(1;17) Cancer Genet Cytogenet 1986 20: 89–93

    Article  CAS  PubMed  Google Scholar 

  23. Yamada K, Sugimoto E, Amano M, Imamura Y, Kubota T, Matsumoto M . Two cases of acute promyelocytic leukemia with variant translocations: the importance of chromosome No. 17 abnormality Cancer Genet Cytogenet 1983 9: 93–99

    Article  CAS  PubMed  Google Scholar 

  24. Salomoni P, Pandolfi PP . The role of PML in tumor suppression Cell 2002 108: 165–170

    Article  CAS  PubMed  Google Scholar 

  25. Guidez F, Ivins S, Zhu J, Soderstrom M, Waxman S, Zelent A . Reduced retinoic acid-sensitivities of nuclear receptor corepressor binding to PML- and PLZF-RARalpha underlie molecular pathogenesis and treatment of acute promyelocytic leukemia Blood 1998 91: 2634–2642

    CAS  PubMed  Google Scholar 

  26. He LZ, Guidez F, Tribioli C, Peruzzi D, Ruthardt M, Zelent A, Pandolfi PP . Distinct interactions of PML-RAR-alpha and PLZF-RAR-alpha with co-repressors determine differential responses to RA in APL Nature Genet 1998 18: 126–135

    Article  CAS  PubMed  Google Scholar 

  27. Chen SJ, Zhu YJ, Tong JH, Dong S, Huang W, Chen Y, Xiang WM, Zhang L, Li XS, Qian GQ, Wang GD, Chen Z, Larsen CJ, Berger R . Rearrangements in the second intron of the RARA gene are present in a large majority of patients with acute promyelocytic leukemia and are used as molecular marker for retinoic acid-induced leukemic cell differentiation Blood 1991 78: 2696–2701

    CAS  PubMed  Google Scholar 

  28. Shekhter-Levin S, Gollin SM, Kaplan SS, Redner RL . Involvement of the MLL and RARalpha genes in a patient with acute monocytic leukemia with t(11;17)(q23;q12) Leukemia 2000 14: 520–522

    Article  CAS  PubMed  Google Scholar 

  29. Hauksdottir H, Privalsky ML . DNA recognition by the aberrant retinoic acid receptors implicated in human acute promyelocytic leukemia Cell Growth Differ 2001 12: 85–98

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Redner RL, Wang J, Liu JM . Chromatin remodeling and leukmia: new therapeutic paradigms Blood 1999 94: 417–428

    CAS  PubMed  Google Scholar 

  31. Grignani F, Dematteis S, Nervi C, Tomassoni L, Gelmetti V, Cioce M, Fanelli M, Ruthardt M, Ferrara FF, Zamir I, Seiser C, Grignani F, Lazar MA, Minucci S, Pelicci PG . Fusion proteins of the retinoic acid receptor-alpha recruit histone deacetylase in promyelocytic leukaemia Nature 1998 391: 815–818

    Article  CAS  PubMed  Google Scholar 

  32. Lin RJ, Nagy L, Inoue S, Shao WL, Miller WH, Evans RM . Role of the histone deacetylase complex in acute promyelocytic leukaemia Nature 1998 391: 811–814

    Article  CAS  PubMed  Google Scholar 

  33. Redner RL, Chen JD, Rush EA, Li H, Pollock SL . The t(5;17) acute promyelocytic leukemia fusion protein NPM-RAR interacts with co-repressor and co-activator proteins and exhibits both positive and negative transcriptional properties Blood 2000 95: 2683–2690

    CAS  PubMed  Google Scholar 

  34. So CW, Dong S, So CK, Cheng GX, Huang QH, Chen SJ, Chan LC . The impact of differential binding of wild-type RARalpha, PML-, PLZF- and NPM-RARalpha fusion proteins towards transcriptional co-activator, RIP-140, on retinoic acid responses in acute promyelocytic leukemia Leukemia 2000 14: 77–83

    Article  CAS  PubMed  Google Scholar 

  35. Dong S, Qiu J, Patel K, Brinkley WR, Mancini MA, Tweardy DA . The coiled-coil domain of NuMA-RAR alpha is essential for its oncogenic activities and localization to NuMA sites within the nucleus Blood 2001 98: 559a

    Google Scholar 

  36. Dong S, Tweardy DJ . Interactions of STAT5b-RARalpha, a novel acute promyelocytic leukemia fusion protein, with retinoic acid receptor and STAT3 signaling pathways Blood 2002 99: 2637–2646

    Article  CAS  PubMed  Google Scholar 

  37. Maurer AB, Wichmann C, Gross A, Kunkel H, Heinzel T, Ruthardt M, Groner B, Grez M . The Stat5-RARalpha fusion protein represses transcription and differentiation through interaction with a corepressor complex Blood 2002 99: 2647–2652

    Article  CAS  PubMed  Google Scholar 

  38. Dyck JA, Gerd GG, Miller WH, Chen JD, Kakizuka A, Evans RM . A novel macromolecular structure is a target of the promyelocyt-retinoic acid receptor oncoprotein Cell 1994 76: 333–343

    Article  CAS  PubMed  Google Scholar 

  39. Weis K, Rambaud S, Lavau C, Jansen J, Carvalho T, Carmo-Fonesca M, Lammond A, Dejean A . Retinoic acid regulates aberrant nuclear localization of PML-RARa in acute promyelocytic leukemia cells Cell 1994 76: 345–356

    Article  CAS  PubMed  Google Scholar 

  40. Negorev D, Maul GG . Cellular proteins localized at and interacting within ND10/PML nuclear bodies/PODs suggest functions of a nuclear depot Oncogene 2001 20: 7234–7242

    Article  CAS  PubMed  Google Scholar 

  41. Redner RL, Schlesinger KW, Pollock SL, Watkins SC . The t(5;17) APL fusion protein NPM-RAR does not alter PML localization Blood 1997 90 (Suppl.): 321a

    Google Scholar 

  42. Leid M, Kastner P, Lyons R, Nakshatri H, Saunders M, Zacharewski T, Chen JY, Staub A, Garnier JM, Mader S, Chambon P . Purification, cloning, and RXR identity of the HeLa cell factor with which RAR or TR heterodimerizes to bind target sequences efficiently Cell 1992 68: 377–395

    Article  CAS  PubMed  Google Scholar 

  43. Mader S, Chen JY, Chen Z, White J, Chambon P, Gronemeyer H . The patterns of binding of RAR, RXR and TR homo- and heterodimers to direct repeats are dictated by the binding specificites of the DNA binding domains EMBO J 1993 12: 5029–5041

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Yu VC, Delsert C, Andersen B, Holloway JM, Devary OV, Naar AM, Kim SY, Boutin JM, Glass CK, Rosenfeld MG . RXR beta: a coregulator that enhances binding of retinoic acid, thyroid hormone, and vitamin D receptors to their cognate response elements Cell 1991 67: 1251–1266

    Article  CAS  PubMed  Google Scholar 

  45. Redner RL, Rush EA, Pollack SA . RXR binding is essential for NPM-RAR inhibition of U937 differentiation Blood 1998 92 (Suppl. 1): 213a

    Google Scholar 

  46. Grignani F, Testa U, Rogaia D, Ferrucci PF, Samoggia P, Pinto A, Aldinucci D, Gelmetti V, Fagioli M, Alcalay M, Seeler J, Grignani F, Nicoletti I, Peschle C, Pelicci PG . Effects on differentiation by the promyelocytic leukemia PML/RARalpha protein depend on the fusion of the PML protein dimerization and RARalpha DNA binding domains EMBO J 1996 15: 4949–4958

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Grignani F, Gelmetti V, Fanelli M, Rogaia D, De Matteis S, Ferrara FF, Bonci D, Nervi C, Pelicci PG . Formation of PML/RAR alpha high molecular weight nuclear complexes through the PML coiled-coil region is essential for the PML/RAR alpha-mediated retinoic acid response Oncogene 1999 18: 6313–6321

    Article  CAS  PubMed  Google Scholar 

  48. Lin RJ, Evans RM . Acquisition of oncogenic potential by RAR chimeras in acute promyelocytic leukemia through formation of homodimers Mol Cell 2000 5: 821–830

    Article  CAS  PubMed  Google Scholar 

  49. Perez A, Kastner P, Sethi S, Lutz Y, Reibel C, Chambon P . PMLRAR homodimers: distinct DNA binding properties and heterodimeric interactions with RXR EMBO J 1993 12: 3171–3182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Licht JD, Shaknovich R, English MA, Melnick A, Li JY, Reddy JC, Dong S, Chen SJ, Zelent A, Waxman S . Reduced and altered DNA-binding and transcriptional properties of the PLZF-retinoic acid receptor-alpha chimera generated in t(11;17)-associated acute promyelocytic leukemia Oncogene 1996 12: 323–336

    CAS  PubMed  Google Scholar 

  51. Warrell RJ, Frankel SR, Miller WJ, Scheinberg DA, Itri LM, Hittelman WN, Vyas R, Andreeff M, Tafuri A, Jakubowski A, Gabrilove J, Gordon MS, Dmitrovsky E . Differentiation therapy of acute promyelocytic leukemia with tretinoin (all-trans-retinoic acid) New Engl J Med 1991 324: 1385–1393

    Article  PubMed  Google Scholar 

  52. Zhu J, Lallemand-Breitenbach V, de The H . Pathways of retinoic acid- or arsenic trioxide-induced PML/RARalpha catabolism, role of oncogene degradation in disease remission Oncogene 2001 20: 7257–7265

    Article  CAS  PubMed  Google Scholar 

  53. Zhang TD, Chen GQ, Wang ZG, Wang ZY, Chen SJ, Chen Z . Arsenic trioxide, a therapeutic agent for APL Oncogene 2001 20: 7146–7153

    Article  CAS  PubMed  Google Scholar 

  54. Pollock JL, Westervelt P, Kurichety AK, Pelicci PG, Grisolano JL, Ley TJ . A bcr-3 isoform of RARalpha-PML potentiates the development of PML-RARalpha-driven acute promyelocytic leukemia Proc Natl Acad Sci USA 1999 96: 15103–15108

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Sitterlin D, Tiollais P, Transy C . The RAR alpha-PLZF chimera associated with acute promyelocytic leukemia has retained a sequence-specific DNA-binding domain Oncogene 1997 14: 1067–1074

    Article  CAS  PubMed  Google Scholar 

  56. He LZ, Bhaumik M, Tribioli C, Rego EM, Ivins S, Zelent A, Pandolfi PP . Two critical hits for promyelocytic leukemia Mol Cell 2000 6: 1131–1141

    Article  CAS  PubMed  Google Scholar 

  57. Redner RL, Rush EA, Wang AS . Divergent roles for the NPM-RAR and RAR-NPM t(5;17) APL fusion proteins in inhibition of myeloid differentiation Blood 2001 98 (Suppl. 2): 154b

    Google Scholar 

  58. Tenen DG . Abnormalities of the CEBP alpha transcription factor: a major target in acute myeloid leukemia Leukemia 2001 15: 688–689

    Article  CAS  PubMed  Google Scholar 

  59. Di Croce L, Raker VA, Corsaro M, Fazi F, Fanelli M, Faretta M, Fuks F, Lo Coco F, Kouzarides T, Nervi C, Minucci S, Pelicci PG . Methyltransferase recruitment and DNA hypermethylation of target promoters by an oncogenic transcription factor Science 2002 295: 1079–1082

    Article  CAS  PubMed  Google Scholar 

  60. Doucas V, Brockes JP, Yaniv M, de Thé H, Dejean A . The PML-retinoic acid receptor alpha translocation converts the receptor from an inhibitor to a retinoic acid-dependent activator of transcription factor AP-1 Proc Nat Acad Sci USA 1993 90: 9345–9349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Fakih MG, Redner RL . Acute promyelocytic leukemia t(5;17) fusion product NPM-RAR down-regulates AP-1 activity in the presence of ATRA Proc AACR 2001

Download references

Acknowledgements

I would like to thank Drs Pam Hershberger, Daniel Johnson, and Richard Steinman for careful reading of the manuscript and to Dr David Tweardy for sharing prepublication data. This work was supported in part by grants from the AICR (01A094) and the NIH (CA67346).

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Redner, R. Variations on a theme: the alternate translocations in APL. Leukemia 16, 1927–1932 (2002). https://doi.org/10.1038/sj.leu.2402720

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2402720

Keywords

This article is cited by

Search

Quick links