We report a case of acute mixed-lineage leukemia, as seen in a 65 year-old female with
MLL gene amplification and biallelic loss of wild type
p53 gene. The diagnosis was based on the findings that her bone marrow (BM) blasts expressed cytoplasmic CD3 (cyCD3), B-lineage antigens and myeloid antigens accompanied by clonal rearrangements of
IgH gene. The BM blasts consisted of small-sized peroxidase-negative blasts (97%) and large-sized peroxidase-positive blasts (3%). The BM blasts showed a complex “karyotype,” including dic(17;20) (p11;q11), -5 and add (11q23). Add (11q23) abnormality was found in sideline karyotypes as well as the stemline abnormality of dic(17;20) (p11;q11). For the
p53 gene, which is located at 17p13, fluorescence
in situ hybridization analysis showed the loss of one of two p53 alleles. Furthermore, polymerase chain reaction-single-strand conformation polymorphism and following nucleotide sequencing showed that the
p53 gene was mutated at codon 215, leading to an amino acid substitution from Ser to Arg. For the
MLL gene, southern blot analysis showed that the
MLL gene locus was amplified but not rearranged at its breakpoint cluster region, which is usually rearranged in balanced translocations with many partner genes. These findings suggest that
MLL gene amplification may in this case be based on the genetic instability caused by the preceding biallelic loss of the wild type
p53 gene. [
J Clin Exp Hematopathol 50(1) : 51-58, 2010]
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