Avaliação da citogenética convencional e molecular em portadores de leucemia promielocítica aguda no Serviço de Hematologia do Hospital das Clínicas da Faculdade de Medicina da USP / Conventional and molecular cytogenetics in patients with acute promyelocytic leukemia of the Hematology Service of Clinical Hospital of São Paulo Medical School

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

INTRODUCTION: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML), characterized by clonal expansion of myeloid precursors blocked at promyelocytic stage, risks of coagulopathy and presence of chromosomal translocations involving RAR (retinoic acid receptor ) gene. Corresponds to the M3 and M3variant subtypes of AML, according to the French-American-British (FAB) classification and the subtype of AML associated with balanced reciprocal translocation between chromosomes 15 and 17 [t (15; 17)] and variants, according to the World Health Organization classification. The clinical APL course has been changed in late years, from highly fatal to highly curable subtype of AML. The introduction of therapeutic agents that act directly on the molecular lesion, such as ATRA and arsenic trioxide, had a great impact on survival of APL. The efficacy of treatment is dependent on genetic rearrangement present in the leukemia cells, the morphologic diagnosis although predictive of the specific genetic lesion genetic, should be quickly confirmed by molecular techniques. METHODS: We analysed cytogenetics findings in 62 patients diagnosed as promyelocytic leukemia by morphological and immunophenotypic studies at the Hematology Service of Clinical Hospital of Sao Paulo Medical School from 1997 to 2006. For this, we used karyotype and FISH with PML-RARA fusion translocation and RARA break-apart probes. RESULTS: Of the 62 patients studied, 59.7% showed the t(15;17)(q22;q21) visible in the karyotype [42.0% had t(15;17) as the sole clonal abnormality, 16.1% showed other additional abnormalities and 1.6% had a complex variant of t(15;17)], 29% had the confirmation of the rearrangement PML-RAR through the FISH-fusion technique and 11.3% showed no break in RAR. No bleeding at diagnosis (p<0.02) and the presence of M3v morphology (p<0.01) were associated to no RAR rearrangement. The 24months overall survival of 55 patients with t(15;17) confirmed by cytogenetics was 49.28%. Two parameters were associated to worse rate of overall survival in this study: age >60 years and M3v morphology . The 24 months disease-free survival was 72.10%. CONCLUSION: 11,3% of patients diagnosed as promyelocytic leukemia by morphological and immunophenotypic studies, showed no consistent cytogenetic diagnosis for this disease. In the absence of bleeding at diagnosis and in the presence of the M3v morphology, FISH test should be prioritized.

ASSUNTO(S)

hibridização in situ por fluorescência cytogenetic analysis leucemia promielocítica aguda fluorescence in situ hybridization promyelocytic acute análise citogenética leukemia

ACESSO AO ARTIGO

Documentos Relacionados