Acute Myeloid Leukemia (AML) with NUP214-ABL1
editPREVIOUS EDITIONThis page from the 4th edition of Haematolymphoid Tumours is being updated. See 5th edition Table of Contents.
Primary Author(s)*
Jessica Snider, M.D. and Daynna J. Wolff, Ph.D.
Cancer Category/Type
Acute Myeloid Leukemia
Cancer Sub-Classification / Subtype
NUP214/ABL1-Mediated Acute Myelomonocytic Leukemia
Definition / Description of Disease
A hematologic neoplasm comprised of myeloblasts that arise from the bone marrow due to amplification at 9q that has breakpoints in the ABL1 and NUP214 gene, resulting in a NUP214-ABL1 gene fusion. NUP214 is required for cell cycle and nucleocytoplasmic transport. The NUP214-ABL1 protein cannot activate the ABL1 tyrosine kinase unless it interacts and competes with other nuclear pore proteins and thus, the amplification of NUP214-ABL1 is necessary for neoplastic transformation and results in a constitutively activated tyrosine kinase with oncogenic potential[1][2]. This gene fusion has recently been identified in one case of acute myeloid leukemia (AML), and prognosis has yet to be determined in this single case.
Synonyms / Terminology
Acute myelocytic leukemia, acute myelogenous leukemia, acute granulocytic leukemia, acute non-lymphocytic leukemia
Epidemiology / Prevalence
One case of NUP214/ABL1-Mediated Acute Myelomonocytic Leukemia has been identified in a 64 year old male after initial treatment with FLT3-directed therapy. This translocation has also been observed in ~6% of all T-cell Acute Lymphoblastic Leukemias and only a few cases of B-cell Acute Lymphoblastic Leukemias[1].
Clinical Features
Fatigue, insomnia, dizziness, splenomegaly
Sites of Involvement
Peripheral blood and bone marrow
Morphologic Features
Leukocytosis consisting of blast-like cells with a high nuclear to cytoplasm ratio and open chromatin as well as mature monocytes can be observed in the peripheral smear. In the bone marrow, the myeloid series consists mostly of blast-like cells with minimal evidence of terminal differentiation. Rare erythroid elements and megakaryocytes may be seen.
Immunophenotype
Myeloblasts express dim CD45, dim CD34, dim CD117, HLA-DR, dim CD33, and dim CD13.
| Finding | Marker |
|---|---|
| Positive (universal) | EXAMPLE CD1 |
| Positive (subset) | EXAMPLE CD2 |
| Negative (universal) | EXAMPLE CD3 |
| Negative (subset) | EXAMPLE CD4 |
Chromosomal Rearrangements (Gene Fusions)
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| Chromosomal Rearrangement | Genes in Fusion (5’ or 3’ Segments) | Pathogenic Derivative | Prevalence |
|---|---|---|---|
| 3'ABL1 / 5'NUP214 | Rare |
Characteristic Chromosomal Aberrations / Patterns
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Genomic Gain/Loss/LOH
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| Chromosome Number | Gain/Loss/Amp/LOH | Region |
|---|---|---|
| 9q | Amp | Chr9:133728488-134083915 |
Additional findings in our case (may or may not be related to NUP214-ABL1 gene fusion):
| Chromosome Number | Gain/Loss/Amp/LOH | Region |
|---|---|---|
| 11q | LOH | Chr11:66206967-135006516 |
| 11q | Amp LOH | Chr11:118335673-118357315 |
| 21q | Loss | Chr21:36209650-36315003 |
Gene Mutations (SNV/INDEL)
In addition to the NUP214-ABL1 gene fusion, the single case identified showed focal deletion of exons 3-8 of RUNX1, loss of heterozygosity of 11q with nested gain of exons 2-10 of the KMT2A (MLL) gene. It is unknown whether or not these additional findings are related to the NUP214-ABL1 gene fusion.
| Gene | Mutation | Oncogene/Tumor Suppressor/Other | Presumed Mechanism (LOF/GOF/Other; Driver/Passenger) | Prevalence (COSMIC/TCGA/Other) |
|---|---|---|---|---|
| EXAMPLE TP53 | EXAMPLE R273H | EXAMPLE Tumor Suppressor | EXAMPLE LOF | EXAMPLE 20% |
Other Mutations
| Type | Gene/Region/Other |
|---|---|
| Concomitant Mutations | EXAMPLE IDH1 R123H |
| Secondary Mutations | EXAMPLE Trisomy 7 |
| Mutually Exclusive | EXAMPLE EGFR Amplification |
Epigenomics (Methylation)
Not applicable.
Genes and Main Pathways Involved
NUP214 (nucleoporin 214) is required for cell cycle and nucleocytoplasmic transport. The protein is located on the cytoplasmic side of the nuclear pore complex. The gene is located at band 9q34.1 and includes 36 exons (1-36). The NUP214-ABL1 protein cannot activate the ABL1 kinase unless it interacts and competes with other nuclear pore proteins and thus, the amplification of NUP214-ABL1 is necessary for neoplastic transformation, resulting in a constitutively activated tyrosine kinase with oncogenic potential[1][2].
RUNX1 is a transcription factor that regulates the differentiation of hematopoietic stem cells into mature blood cells. RUNX proteins form a heterodimeric complex with CBFβ which confers increased DNA binding and stability to the complex.
KMT2A encodes a transcriptional coactivator that plays an essential role in regulating gene expression during early development and hematopoiesis.
Diagnostic Testing Methods
Classical cytogenetics, FISH and molecular genetics.
Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications)
No data has been reported on the prognosis of a NUP214-ABL1 fusion in AML. RUNX1 deletions have been reported to be an independent marker for a shorter event free survival, having a decreased overall survival and demonstrate resistance to chemotherapy[3]. The presence of a partial tandem duplication of the KMT2A gene has been reported to have an overall unfavorable prognosis with shorter remission with relapse generally occurring in the first year[4].
Familial Forms
No familial forms have been documented.
Other Information
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Links
References
- ↑ 1.0 1.1 1.2 Zhou, Min-Hang; et al. (2014). "NUP214 fusion genes in acute leukemia (Review)". Oncology Letters. 8 (3): 959–962. doi:10.3892/ol.2014.2263. ISSN 1792-1074. PMC 4114590. PMID 25120641.
- ↑ 2.0 2.1 Duployez, Nicolas; et al. (2016). "NUP214-ABL1 fusion defines a rare subtype of B-cell precursor acute lymphoblastic leukemia that could benefit from tyrosine kinase inhibitors". Haematologica. 101 (4): e133–e134. doi:10.3324/haematol.2015.136499. ISSN 0390-6078. PMC 5004396. PMID 26681761.
- ↑ Takahashi, Shinichiro (2011). "Current findings for recurring mutations in acute myeloid leukemia". Journal of Hematology & Oncology. 4: 36. doi:10.1186/1756-8722-4-36. ISSN 1756-8722. PMC 3180439. PMID 21917154.
- ↑ Schnittger, S.; et al. (2000). "Screening for MLL tandem duplication in 387 unselected patients with AML identify a prognostically unfavorable subset of AML". Leukemia. 14 (5): 796–804. doi:10.1038/sj.leu.2401773. ISSN 0887-6924. PMID 10803509.
Notes
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