ALK-positive anaplastic large cell lymphoma

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Haematolymphoid Tumours (5th ed.)

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Primary Author(s)*

Miguel Gonzalez Mancera, MD, Cedars-Sinai, Los Angeles, CA

Sumire Kitahara, MD, Cedars-Sinai, Los Angeles, CA

Cancer Category / Type

Cancer Sub-Classification / Subtype

  • Systemic T-cell lymphoma

Definition / Description of Disease

Anaplastic Large Cell Lymphoma, ALK-Positive (ALK+ ALCL) is a T-cell lymphoma characterized by usually large lymphoma cells with abundant cytoplasm and pleomorphic nuclei, often horse-shoe shaped (see Morphologic Features below), with a chromosomal rearrangement involving the ALK gene resulting in expression of ALK protein and CD30

Synonyms / Terminology

  • Ki-1 (CD30) lymphoma - obsolete

Epidemiology / Prevalence

  • ALCL (ALK+, ALK-, and primary cutaneous) account for <5% of all cases of non-Hodgkin lymphoma (NHL)[1]
  • ALK+ ALCL[1]
    • ~3% of adult NHL
    • 10-20% of childhood lymphomas
    • Most frequent in the first three decades of life
    • Male:female = 1.5:1

Clinical Features

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Signs and Symptoms Most patients (70%) present with advanced (stage III-IV) disease and B-symptoms.[2]
Laboratory Findings Noncontributory


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  • Most patients (70%) present with advanced (stage III-IV) disease and B-symptoms.[2]

Sites of Involvement

  • Lymph nodes and extranodal sites (most commonly skin, bone, soft tissue, lungs and liver)[1]
  • Bone marrow involvement detected in 30% when using immunohistochemistry (CD30 and EMA). Can miss marrow involvement by H&E evaluation alone, which detects involvement with ~10% incidence.[3]


editUnassigned References
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[1]

Morphologic Features

"Hallmark cells"[4][5]

  • Lymphoma cells characterized by eccentric, horseshoe-shaped or kidney-shaped nuclei, often with eosinophilic cytoplasm accentuated near the nucleus
  • Usually large in size, but may also be smaller
  • Present in varying proportions
  • Seen in all morphological variants/patterns of ALK+ ALCL

Morphological variants/patterns

  1. Common (60%): predominant population of large hallmark cells
  2. Lymphohistiocytic (10%): lymphoma cells are admixed with numerous reactive histiocytes that may obscure the lymphoma cells; lymphoma cells often cluster around vessels and are often smaller than in the common pattern
  3. Small cell (5-10%): predominant population of smaller lymphoma cells; hallmark cells are often concentrated around vessels; may also see "fried egg cells" (pale cytoplasm with central nucleus) or signet ring-like cells; can misdiagnose of peripheral T-cell lymphoma, NOS
  4. Hodgkin-like (3%): mimics nodular sclerosis classic Hodgkin lymphoma
  5. Composite (15%): more than one pattern in a single lymph node

When lymph node is only partially involved, lymphoma characteristically grows in the sinuses, which may mimic a metastatic tumor.

Immunophenotype

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CD30 expression on ALCL (ALK+ or ALK-) allows for targeted therapy[6]

  • First-line therapy: Brentuximab (anti-CD30) vedotin + CHP (cyclophosphamide, doxorubicin, and prednisone)
Finding Marker
Positive (universal) - Cell membrane and Golgi; large lymphoma cells show strongest staining; smaller cells may show weak, partial to negative staining CD30
Positive (universal) - Cellular location of ALK staining varies depending on ALK translocation partner. In the most common t(2;5), most cases show both cytoplasmic and nuclear ALK
Positive (subset) EMA
Negative - >75% of cases are CD3-negative CD3
Positive (70%) CD4
Negative in majority of cases CD8
Positive in majority of cases CD2
Positive in majority of cases CD5
Positive TIA1
Positive Granzyme B
Positive Perforin
Variably positive CD45
Positive (universal) CD25
Negative (universal) BCL2


editv4:Immunophenotype
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ALK+ ALCL show the following staining pattern[7][8]:

  • CD30+: Cell membrane and Golgi; large lymphoma cells show strongest staining; smaller cells may show weak, partial to negative staining
  • ALK+: cellular location of ALK staining varies depending on ALK translocation partner. In the most common t(2;5), most cases show both cytoplasmic and nuclear ALK staining. In the small cell variant, staining is usually restricted to the nucleus
  • EMA+: some cases show positivity in only a proportion of lymphoma cells
  • CD3(-): >75% of cases are CD3-negative
  • CD4>>>CD8
  • CD2 and CD5: Majority positive
  • Cytotoxic marker(s)+: TIA1, granzyme B and/or perforin
  • CD45: variably positive
  • CD25+
  • BCL2-negative

Chromosomal Rearrangements (Gene Fusions)

FISH is not required for diagnosis in routine practice [9][10].

Chromosomal Rearrangement Genes in Fusion (5’ or 3’ Segments) Pathogenic Derivative Prevalence Diagnostic Significance (Yes, No or Unknown) Prognostic Significance (Yes, No or Unknown) Therapeutic Significance (Yes, No or Unknown) Notes
t(2;5)(p23;q35) 3' ALK / 5' NPM1[11] NPM1::ALK fusion protein 84%[1] No No Yes Approximately 80% of cases show a cytogenetic translocation t(2;5) (NPM1-ALK, t(2;5)(p23;q35)) which fuses the ALK gene to the nucleophosmine (NPM) gene at 5q35, resulting in the overexpression and constitutive activation of a chimeric ALK fusion protein, which plays an important role in ALK-mediated oncogenesis.


Of note, identifying the ALK fusion partner is not considered necessary in routine clinical practice.


Detecting minimal residual disease by PCR for NPM1-ALK (not readily commercially available) in bone marrow and peripheral blood during treatment could identify patients at risk of relapse[12]


ALK inhibition (crizotinib) can be an effective 2nd-line therapeutic strategy as ALK is essential for the proliferation and survival of ALK+ ALCL cells[13][6][14]

  • Drug resistance may develop due to:
    1. Mutations of the ALK gene impairing binding of the inhibitor[15]; other ALK inhibitors are not currently FDA-approved for use in ALK+ ALCL
    2. See also gene mutations section above
    3. Engagement of other cell signaling pathways
t(1;2)(q25;p23)[16] 3' ALK / 5' TPM3 TPM3::ALK Fusion protein 13%[16] No No No
inv(2)(p23q35)[17] 3' ALK / 5' ATIC ATIC::ALK fusion protein 1% [17] No No No
t(2;3)(p23;q12.2)[18] 3' ALK / 5' TFG TFG::ALK fusion protein <1% No No No
t(2;17)(p23;q23)[19] 3' ALK / 5' CLTC CLTC::ALK fusion protein <1% No No No
t(X;2)(q11-22;p23)[20] 3' ALK / 5' MSN MSN::ALK fusion protein <1% No No No
t(2;19)(p23;p13.1)[21] 3' ALK / 5' TPM4 TPM4::ALK fusion protein <1% No No No
t(2;22)(p23;q11.2)[22] 3' ALK / 5' MYH9 MYH9::ALK fusion protein <1% No No No
t(2;17)(p23;q25)[21] 3' ALK / 5' RNF213 RNF213::ALK fusion protein <1% No No No
t(2;9)(p23;q33)[23] 3' ALK / 5' TRAF-1 TRAF-1::ALK fusion protein <1% No No No


editv4:Chromosomal Rearrangements (Gene Fusions)
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  • ALK(+) ALCL is characterized by chromosomal translocations involving ALK gene, a receptor tyrosine kinase domain at 2p23.
  • Approximately 80% of cases show a cytogenetic translocation t(2;5) (NPM1-ALK, t(2;5)(p23;q35)) which fuses the ALK gene to the nucleophosmine (NPM) gene at 5q35, resulting in the overexpression and constitutive activation of a chimeric ALK fusion protein, which plays an important role in ALK-mediated oncogenesis.[11]
  • ALK translocations may be seen in multiple malignancies including epithelial malignancies[24][25][26][27][28][29], inflammatory myofibroblastic tumor[30][31][32], non-Hodgkin's lymphoma[33][34][35], and ALK+ histiocytosis [36][37][38].
FISH break apart probe for ALK gene showing a split signal indicating ALK rearrangement in a case of ALK(+) ALCL.


Table below shows described ALK translocations with ALK staining pattern, and frequency of cases. Of note, identifying the ALK fusion partner is not considered necessary in routine clinical practice.

Chromosomal

Anomaly

ALK partner ALK staining pattern Percentage

of cases

t(2;5)(p23;q35) NPM1 Nuclear, nucleolar, diffuse cytoplasmic 84%
t(1;2)(q25;p23)[16] TPM3 Diffuse cytoplasmic with peripheral intensification 13%
inv(2)(p23q35)[17] ATIC Diffuse cytoplasmic 1%
t(2;3)(p23;q12.2)[18] TFG Diffuse cytoplasmic <1%
t(2;17)(p23;q23)[19] CLTC Granular cytoplasmic <1%
t(X;2)(q11-22;p23)[20] MSN Membrane <1%
t(2;19)(p23;p13.1)[21] TPM4 Diffuse cytoplasmic <1%
t(2;22)(p23;q11.2)[22] MYH9 Diffuse cytoplasmic <1%
t(2;17)(p23;q25)[21] RNF213 Diffuse cytoplasmic <1%
t(2;9)(p23;q33)[23] TRAF-1 Diffuse cytoplasmic <1%


editv4:Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications).
Please incorporate this section into the relevant tables found in:
  • Chromosomal Rearrangements (Gene Fusions)
  • Individual Region Genomic Gain/Loss/LOH
  • Characteristic Chromosomal Patterns
  • Gene Mutations (SNV/INDEL)

Diagnosis

  • As stated above, the diagnosis is based on histology and immunohistochemistry
  • FISH is not required for diagnosis in routine practice [9][10]

Prognosis

  • ALK+ ALCL has a better survival rate compared to ALK-negative ALCL
    • However, differences in patient age (younger in ALK+) may account for this better survival[39]
  • Different ALK translocation partners do not have prognostic significance
  • Survival is predicted by International Prognostic Index (IPI) with overall long term survival rate approaching 80%
  • Detecting minimal residual disease by PCR for NPM1-ALK (not readily commercially available) in bone marrow and peripheral blood during treatment could identify patients at risk of relapse[12]
  • Small-cell or lymphohistiocytic patterns tend to present with disseminated disease and have a less favorable prognosis than the common pattern[40]
  • NOTCH1 may be a biomarker for risk of relapse[41]

Therapy

  • CD30 expression on ALCL (ALK+ or ALK-) allows for targeted therapy[6]
    • First-line therapy: Brentuximab (anti-CD30) vedotin + CHP (cyclophosphamide, doxorubicin, and prednisone)
  • ALK inhibition (crizotinib) can be an effective 2nd-line therapeutic strategy as ALK is essential for the proliferation and survival of ALK+ ALCL cells[13][6][14]
    • Drug resistance may develop due to:
      1. Mutations of the ALK gene impairing binding of the inhibitor[15]; other ALK inhibitors are not currently FDA-approved for use in ALK+ ALCL
      2. See also gene mutations section above
      3. Engagement of other cell signaling pathways
  • Preclinical models suggest role of:
    • Combination therapy with hypomethylating agents (such as azacitidine) and epigenetic modifying drugs (such as romidepsin, a histone deacetylase inhibitor)[42]
    • Inhibitors of HSP90 and mTOR inhibition[15]
    • NOTCH1 inhibition by γ-secretase inhibitors (GSI) in combination with crizotinib may provide synergistic anti-tumor activity, or as a single agent in ALK-inhibitor resistant cell lines[41]

Individual Region Genomic Gain / Loss / LOH

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Chr # Gain / Loss / Amp / LOH Minimal Region Genomic Coordinates [Genome Build] Minimal Region Cytoband Diagnostic Significance (Yes, No or Unknown) Prognostic Significance (Yes, No or Unknown) Therapeutic Significance (Yes, No or Unknown) Notes
17p Gain 17p11-pter No Unclear No
17p Gain 17q24 -qter No Unclear No
4q Loss 4q13-q28 No Unclear No
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Frequent secondary chromosomal imbalances are seen in ALK+ ALCL (58% of cases), as based on comparative genomic hybridization analysis[43].

Chromosome Number Gain/Loss/Amp/LOH Frequency Comment
2q Gain 12%
4q Loss 28%
11q22 (ATM) Loss, LOH 28%
13q Loss 28% Also see in ALK- cases
7p Gain 12% Also seen in ALK- cases
17p13 (TP53) Gain 28%
17p13 (TP53) Loss[44] 9% More common in ALK- cases (42%)
17q24-qter Gain 28%

Characteristic Chromosomal Patterns

Put your text here (EXAMPLE PATTERNS: hyperdiploid; gain of odd number chromosomes including typically chromosome 1, 3, 5, 7, 11, and 17; co-deletion of 1p and 19q; complex karyotypes without characteristic genetic findings; chromothripsis)

Chromosomal Pattern Diagnostic Significance (Yes, No or Unknown) Prognostic Significance (Yes, No or Unknown) Therapeutic Significance (Yes, No or Unknown) Notes
EXAMPLE

Co-deletion of 1p and 18q

Yes No No EXAMPLE:

See chromosomal rearrangements table as this pattern is due to an unbalanced derivative translocation associated with oligodendroglioma (add reference).

editv4:Characteristic Chromosomal Aberrations / Patterns
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See other sections.

Gene Mutations (SNV / INDEL)

Put your text here and fill in the table (Instructions: This table is not meant to be an exhaustive list; please include only genes/alterations that are recurrent and common as well either disease defining and/or clinically significant. Can include references in the table. For clinical significance, denote associations with FDA-approved therapy (not an extensive list of applicable drugs) and NCCN or other national guidelines if applicable; Can also refer to CGC workgroup tables as linked on the homepage if applicable as well as any high impact papers or reviews of gene mutations in this entity.)

Gene; Genetic Alteration Presumed Mechanism (Tumor Suppressor Gene [TSG] / Oncogene / Other) Prevalence (COSMIC / TCGA / Other) Concomitant Mutations Mutually Exclusive Mutations Diagnostic Significance (Yes, No or Unknown) Prognostic Significance (Yes, No or Unknown) Therapeutic Significance (Yes, No or Unknown) Notes
LRP1B[45] TSG 19% No No No No No
NOTCH1[41] Activating mutation 9.3% (p.Thr349Pro)

10.2% (p.Thr311Pro)

No No No No Yes May be a biomarker for risk of relapse[41]
TP53[45] TSG 11% No No No Yes No
ALK[46][47][48][49][50][51][52] Therapeutic Resistance mutations No No No Yes ALK kinase domain secondary mutations, including L1196 M, G1269A, L1152R, C1156Y, I1171T, F1174 L, G1202R, and S1206Y, have been identified as the key mechanism of resistance

Note: A more extensive list of mutations can be found in cBioportal (https://www.cbioportal.org/), COSMIC (https://cancer.sanger.ac.uk/cosmic), ICGC (https://dcc.icgc.org/) and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.


editv4:Gene Mutations (SNV/INDEL)
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  • Limited literature on somatic mutations in ALK+ ALCL
Gene Function or Presumed Mechanism Frequency
LRP1B[45] Tumor suppressor 19%
NOTCH1[41] Activating 9.3% (p.Thr349Pro)

10.2% (p.Thr311Pro)

TP53[45] Tumor suppressor 11%
  • Epigenetic modifier genes: KMT2D, TET2, EP300, KMT2C[45]
  • Other mutations: EPHA5


Negative genes mutations:

  • JAK1, STAT3: Mutations described in ALK(-) ALCL[53], and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)[54]
  • RHOA, DNMT3A, CD28: Mutations described in peripheral T cell-lymphoma (PTCL), NOS, and in angioimmunoblastic T-cell lymphoma (AITL)[55]
  • IDH2 mutations are relatively specific for AITL[56][57]

A variety of mechanisms for the acquired resistance to ALK inhibitors, such as crizotinib, have been described:

  • ALK kinase domain secondary mutations, including L1196 M, G1269A, L1152R, C1156Y, I1171T, F1174 L, G1202R, and S1206Y, have been identified as the key mechanism of resistance[52][46][47][48][49][50][51]
  • The G1269A mutation, in which the glycine at 1269 is substituted with an alanine, causes steric hindrance, resulting in decreased affinity for crizotinib.[58][59]
  • Gain in ALK copy number and loss of ALK gene rearrangement have also been implicated in the development of acquired resistance to crizotinib.[47][48][49]

Epigenomic Alterations

  • NPM-ALK via STAT3-activated DNA methyltransferases[60] uses epigenetic silencing mechanisms to:
    • Downregulate tumor suppressor genes to maintain its own expression (i.e. to inhibit downregulation of NPM-ALK). Silenced tumor suppressors include:
      • STAT5A[61]
      • SHP-1 phosphotyrosine phosphatase[62]
      • IL-2Rγ[63]
      • miR-150[64]
      • DNMT1 mRNA inhibitor miR-21[63]
    • Silence T-cell receptor complex and signaling pathway (CD3e, ZAP70, LAT, SLP76)[65]
  • Histone H3 lysine 27 (H3K27) trimethylation silences promoters of important T-cell transcription factor genes (GATA3, TCF1 and LEF1)[66]
  • Reader is directed to this review for more comprehensive review of epigenetics in peripheral T-cell lymphomas[67]

Genes and Main Pathways Involved

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Gene; Genetic Alteration Pathway Pathophysiologic Outcome
ALK; fusion protein derivatives Ras-ERK Increased cell growth and proliferation
ALK; fusion protein derivatives JAK/STAT3 Cell survival and phenotypic changes
ALK; fusion protein derivatives PI3K/AKT/mTOR Cell survival and phenotypic changes
editv4:Genes and Main Pathways Involved
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  • Activation of the ALK catalytic domain leads to the oncogenic properties of the ALK protein, leading to activation of multiple signaling cascades including[68]:
    • RAS-ERK
    • JAK/STAT
      • STAT3 is a pivotal transcription factor in most ALCL subtypes:
        • NPM1/ALK and variants lead to expression of ALK fusion proteins with constitutive ALK tyrosine kinase activity, which converges in the activation of the downstream oncogenic transcription factor STAT3[53][55].
        • In the absence of ALK fusions there are activation JAK1 and/or STAT3 mutations in ALK(-) ALCL [53], and some BIA-ALCL. [69].
    • PI3K/AKT/mTOR
  • ALK-NPM-STAT3 induces:
    • See Epigenomics section above
    • TGF beta, IL-10, PD-L1/CD274 to create immunosuppressive microenvironment and evasion of immune system[70][71][72]
    • ICOS expression (CD28 costimulatory receptor superfamily)
    • HIF1α expression induces expression of VEGF (tumor angiogenesis); allows lymphoma cells to adapt to hypoxic conditions[73]
  • Expression of embryonic genes (SOX2, SALL4) promoting stem cell-like program
  • Deregulation of microRNAs (miR-155, miR-101, miR-17-92 cluster, miR-26a, miR-16)[74][75][76][77][78]

Genetic Diagnostic Testing Methods

  • Diagnosis is based on histologic evaluation and immunohistochemical positivity for CD30 and ALK on the T-lymphoma cells.
  • FISH using an ALK breakapart probe or karyotype analysis can detect ALK translocations, but is not required for diagnosis as it can be established by morphology and immunohistochemistry.

Familial Forms

  • None

Additional Information

  • None

Links

  • See References.

References

(use the "Cite" icon at the top of the page) (Instructions: Add each reference into the text above by clicking on where you want to insert the reference, selecting the “Cite” icon at the top of the page, and using the “Automatic” tab option to search such as by PMID to select the reference to insert. The reference list in this section will be automatically generated and sorted. If a PMID is not available, such as for a book, please use the “Cite” icon, select “Manual” and then “Basic Form”, and include the entire reference.)

  1. 1.0 1.1 1.2 1.3 1.4 Arber DA, et al., (2017). Anaplastic large cell lymphoma, ALK-positive, in World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. IARC Press: Lyon, France, p413-418.
  2. 2.0 2.1 Savage, Kerry J.; et al. (2008-06-15). "ALK- anaplastic large-cell lymphoma is clinically and immunophenotypically different from both ALK+ ALCL and peripheral T-cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project". Blood. 111 (12): 5496–5504. doi:10.1182/blood-2008-01-134270. ISSN 1528-0020. PMID 18385450.
  3. M, Fraga; et al. (1995). "Bone marrow involvement in anaplastic large cell lymphoma. Immunohistochemical detection of minimal disease and its prognostic significance". PMID 7817951.
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  5. Benharroch, D.; et al. (1998-03-15). "ALK-positive lymphoma: a single disease with a broad spectrum of morphology". Blood. 91 (6): 2076–2084. ISSN 0006-4971. PMID 9490693.
  6. 6.0 6.1 6.2 6.3 National Comprehensive Cancer Network (January 2021). "NCCN Clinical Practice Guidelines in Oncology: T-cell lymphomas" (PDF).CS1 maint: display-authors (link)
  7. Montes-Mojarro, Ivonne A.; et al. (2018-04-04). "The Pathological Spectrum of Systemic Anaplastic Large Cell Lymphoma (ALCL)". Cancers. 10 (4): E107. doi:10.3390/cancers10040107. ISSN 2072-6694. PMC 5923362. PMID 29617304.
  8. Stein, H.; et al. (2000-12-01). "CD30(+) anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features". Blood. 96 (12): 3681–3695. ISSN 0006-4971. PMID 11090048.
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  11. 11.0 11.1 Morris, S. W.; et al. (1994-03-04). "Fusion of a kinase gene, ALK, to a nucleolar protein gene, NPM, in non-Hodgkin's lymphoma". Science (New York, N.Y.). 263 (5151): 1281–1284. doi:10.1126/science.8122112. ISSN 0036-8075. PMID 8122112.
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  13. 13.0 13.1 Werner, Michael T.; et al. (02 16, 2017). "Nucleophosmin-anaplastic lymphoma kinase: the ultimate oncogene and therapeutic target". Blood. 129 (7): 823–831. doi:10.1182/blood-2016-05-717793. ISSN 1528-0020. PMID 27879258. Check date values in: |date= (help)
  14. 14.0 14.1 Food and Drug Administration (January 2021). "FDA approves crizotinib for children and young adults with relapsed or refractory, systemic anaplastic large cell lymphoma".CS1 maint: display-authors (link)
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  16. 16.0 16.1 16.2 Lamant, L.; et al. (1999-05-01). "A new fusion gene TPM3-ALK in anaplastic large cell lymphoma created by a (1;2)(q25;p23) translocation". Blood. 93 (9): 3088–3095. ISSN 0006-4971. PMID 10216106.
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  20. 20.0 20.1 Tort, F.; et al. (2001-03). "Molecular characterization of a new ALK translocation involving moesin (MSN-ALK) in anaplastic large cell lymphoma". Laboratory Investigation; a Journal of Technical Methods and Pathology. 81 (3): 419–426. doi:10.1038/labinvest.3780249. ISSN 0023-6837. PMID 11310834. Check date values in: |date= (help)
  21. 21.0 21.1 21.2 21.3 Cools, Jan; et al. (2002-08). "Identification of novel fusion partners of ALK, the anaplastic lymphoma kinase, in anaplastic large-cell lymphoma and inflammatory myofibroblastic tumor". Genes, Chromosomes & Cancer. 34 (4): 354–362. doi:10.1002/gcc.10033. ISSN 1045-2257. PMID 12112524. Check date values in: |date= (help)
  22. 22.0 22.1 Lamant, Laurence; et al. (2003-08). "Non-muscle myosin heavy chain (MYH9): a new partner fused to ALK in anaplastic large cell lymphoma". Genes, Chromosomes & Cancer. 37 (4): 427–432. doi:10.1002/gcc.10232. ISSN 1045-2257. PMID 12800156. Check date values in: |date= (help)
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Notes

*Primary authors will typically be those that initially create and complete the content of a page.  If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the CCGA coordinators (contact information provided on the homepage).  Additional global feedback or concerns are also welcome.

*Citation of this Page: “ALK-positive anaplastic large cell lymphoma”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated 07/23/2024, https://ccga.io/index.php/HAEM5:ALK-positive_anaplastic_large_cell_lymphoma.

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Primary Authors*


Miguel Gonzalez Mancera, MD

Sumire Kitahara, MD

Cedars-Sinai, Los Angeles, CA