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Prognostic impact of t(9;11) in childhood acute myeloid leukemia (AML)

Leukemia volume 17, page 636 (2003)Cite this article

TO THE EDITOR

We read with considerable interest the recent report by Rubnitz et al,1 regarding the occurrence of t(9;11)(p22;q23) as the most favorable genetic factor for children with acute myeloid leukemia (AML) who were treated at their institution. Although we agree with the authors’ conclusions, we would emphasize the unfavorable prognostic value of t(9;11) occurrence in association with additional chromosomal alterations and/or with a FAB different from M5. In order to support this concept, we report here a case of a 2-year-old boy presenting with an AML FAB M1 and low white blood cell (WBC) count who was diagnosed and treated with a BFM protocol at the Center of Pediatric Hematology Oncology, University of Catania. The cytogenetic analyses, performed at the Gaslini Hospital, showed the presence of the t(9;11)(p22;q23) with additional chromosomal abnormalities [46,Y,der(X) (9qter->9q34::Xp11.2->Xqter) (der(9)(11qter->11q23::9p22->9q34::17q2?4->17qter), der(11) (11pter->11q23::9p22>9pter), der(17) (17pter->17q2?4::Xp 11.2->Xpter). The child achieved morphological remission after two courses of induction therapy. Since he withdrew the consolidation phase, he suffered from a chronic thrombocytopenia. The bone marrow (BM) aspirate showed a low number of blasts. We consistently detected the fusion transcript MLL-AF9 using a recently described RT-PCR protocol.2 The child then underwent a reinduction therapy (IDA-FLAG), achieving a partial morphological remission. As a last resort, we subsequently performed an allogeneic BM transplantation (BMT) from a sibling HLA-matched donor using low doses of cyclosporin as graft-versus-host (GVH) disease prevention in an attempt to induce a graft-versus-leukemia phenomenon. Interestingly, the patient achieved remission after a cutaneous grade III GVH. However, at 60 days from BM infusion, he presented with second isolated (BM) relapse. As a result of the high expression of CD33 antigen in patient's blasts, we decided to treat him with mylotarg followed by a second BMT. Unfortunately, after the second administration of anti-CD33 drug, the child died of infectious complication (aspergillosis).

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Acknowledgements

This study was supported in part by a grant from ‘Regione Siciliana’ and in part by a grant from Associazione Italiana Ricerca sul Cancro (AIRC), and by a grant from Fondazione Gerolamo Gaslini.

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Authors and Affiliations

  1. Center of Pediatric Hematology Oncology, Azienda Policlinico University of Catania, Italy

    Luca Lo Nigro, Daria Bottino, Elena Mirabile, Andrea Di Cataldo & Gino Schiliro

  2. Department of Pediatric Hematology Oncology Istituto “Gianina Gaslini”, Cancer Cytogenetic Laboratory, Genova, Italy

    Claudio Panarello, Cristina Morerio & Anna Maria Rapella

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  1. Luca Lo Nigro
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  2. Daria Bottino
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Nigro, L., Bottino, D., Panarello, C. et al. Prognostic impact of t(9;11) in childhood acute myeloid leukemia (AML). Leukemia 17, 636 (2003). https://doi.org/10.1038/sj.leu.2402846

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