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t(2;5)(p23;q35) NPM1::ALK

Written2001-08Jean-Loup Huret
Genetics, Dept Medical Information, University of Poitiers, CHU Poitiers Hospital, F-86021 Poitiers, France
This article is an update of :
1997-12Jean-Loup Huret
Genetics, Dept Medical Information, University of Poitiers, CHU Poitiers Hospital, F-86021 Poitiers, France
1997-08Jean-Loup Huret
Genetics, Dept Medical Information, University of Poitiers, CHU Poitiers Hospital, F-86021 Poitiers, France

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Atlas_Id 2000
  t(2;5)(p23;q35) NPM1/ALK G-banding (left) [note tetraploid cells (second and third row)] and R- banding (right); - Courtesy Jean-Luc Lai and Alain Vanderhaegen; center: G-banding - Courtesy Adriana Zamecnikova. Fluorescence in situ hybridization (FISH) with Vysis ALK Break Apart probe (Abbott Molecular, US) showing rearrangement of the gene on metaphases with t(2;5)(p23;q35) (green signal on der(2) and red signal on der(5) chromosome). - Courtesy Adriana Zamecnikova.

Clinics and Pathology

Disease Translocations involving 2p23 are found in more than half cases of anaplasic large cell lymphoma (ALCL), a high grade non Hodgkin lymphoma (NHL). They involve ALK, and are therefore called ALK+ ALCL. The t(2;5) is the far most frequent 2p23 translocation in ALK+ ALCL.
Phenotype / cell stem origin T-cell in 80% (or 100%?), or null-cell type; B-cell cases, if they exist, would represent cases of large B-cell lymphomas; CD30+; present with some overlapping features with Hodgkin's disease: CD30 positivity and Reed-Sternberg like cells, but the t(2;5) is not found in Hodgkin's disease (it has long been debated)
Epidemiology 10% of NHL; found in children and young adults; median around 16 yrs)
Clinics involve lymph nodes and extra nodal sites such as lungs and gastro intestinal tract
Cytology t(2;5) is found in about 30-50% of anaplastic large cell NHL (also called ALCL); it was thought previously that the t(2;5) could be found in diffuse large cell NHL or immunoblastic NHL; however, cases may easily be misdiagnosed, as the malignant cells display a pleomorphic appearance
Prognosis although t(2;5) is found in aggressive high grade tumours, a 80% five yr survival seems to be associated with this anomaly


Additional anomalies sole anomaly in less than 20% of cases; often part of a complex karyotype, with various structural and/or numerical anomalies; recurrent numerical anomalies are: +7, found in 20% of cases, +9, and +X, in 5 to 10% of cases.
Variants closely related anomalies, also found in anaplastic large cell lymphoma, are: t(X;2)(q11;p23), t(1;2)(q25;p23), inv(2)(p23q35), t(2;3)(p23;q21), t(2;17)(p23;q23), t(2;19)(p23; p13.1) and t(2;22)(p23;q11.2). They all involve ALK in 2p23.

Genes involved and Proteins

Gene NameALK (anaplastic lymphoma receptor tyrosine kinase)
Location 2p23.2
Protein after glycosylation, produces a glycoprotein; membrane associated tyrosine kinase receptor
Gene NameNPM1 (nucleophosmin)
Location 5q35.1
Protein nuclear localisation; RNA binding nucleolar phosphoprotein involved in preribosomal assembly

Result of the chromosomal anomaly

Hybrid gene
Description 5' NPM-3' ALK on der(5)
Transcript 2.4 kb
Fusion Protein
Description 80 kDa; 680 amino acids; the 116 N-term aminoacids from NPM are fused to the 563 C-term aminoacids of ALK (i.e. composed of the oligomerization domain and the metal binding site of NPM1, and the entire cytoplasmic portion of ALK); no apparent expression of the ALK/NPM1 counterpart. Characteristic localisation both in the cytoplasm and in the nucleus, due to heterooligomerization of NPM-ALK and normal NPM whereas the normal NPM protein is confined to the nucleus; constitutive activation of the catalytic domain of ALK.
Expression Localisation localisation: both in the cytoplasm and in the nucleus (nucleoplasm and nucleolus)
Oncogenesis via the kinase function activated by oligomerization of NPM-ALK mediated by the NPM part


Role of the nucleophosmin (NPM) portion of the non-Hodgkin's lymphoma-associated NPM-anaplastic lymphoma kinase fusion protein in oncogenesis.
Bischof D, Pulford K, Mason DY, Morris SW
Molecular and cellular biology. 1997 ; 17 (4) : 2312-2325.
PMID 9121481
Cytogenetics of lymphomas: a brief review of its theoretical and practical significance.
Donner LR
Cancer genetics and cytogenetics. 1997 ; 94 (1) : 20-26.
PMID 9078287
CD30-positive large cell lymphomas ('Ki-1 lymphoma') are associated with a chromosomal translocation involving 5q35.
Mason DY, Bastard C, Rimokh R, Dastugue N, Huret JL, Kristoffersson U, Magaud JP, Nezelof C, Tilly H, Vannier JP
British journal of haematology. 1990 ; 74 (2) : 161-168.
PMID 2156548
Fusion of a kinase gene, ALK, to a nucleolar protein gene, NPM, in non-Hodgkin's lymphoma.
Morris SW, Kirstein MN, Valentine MB, Dittmer KG, Shapiro DN, Saltman DL, Look AT
Science (New York, N.Y.). 1994 ; 263 (5151) : 1281-1284.
PMID 8122112
Alk+ CD30+ lymphomas: a distinct molecular genetic subtype of non-Hodgkin's lymphoma.
Morris SW, Xue L, Ma Z, Kinney MC
British journal of haematology. 2001 ; 113 (2) : 275-295.
PMID 11380391
CD30(+) anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features.
Stein H, Foss HD, Dürkop H, Marafioti T, Delsol G, Pulford K, Pileri S, Falini B
Blood. 2000 ; 96 (12) : 3681-3695.
PMID 11090048
Analysis of the t(2;5)(p23;q35) translocation by reverse transcription-polymerase chain reaction in CD30+ anaplastic large-cell lymphomas, in other non-Hodgkin's lymphomas of T-cell phenotype, and in Hodgkin's disease.
Wellmann A, Otsuki T, Vogelbruch M, Clark HM, Jaffe ES, Raffeld M
Blood. 1995 ; 86 (6) : 2321-2328.
PMID 7662979


This paper should be referenced as such :
Huret, JL
Atlas Genet Cytogenet Oncol Haematol. 2001;5(4):283-285.
Free journal version : [ pdf ]   [ DOI ]
On line version :
History of this paper:
Huret, JL. t(2;5)(p23;q35). Atlas Genet Cytogenet Oncol Haematol. 1997;1(2):92-93.
Huret, JL. t(4;11)(q21;q23). Atlas Genet Cytogenet Oncol Haematol. 1997;1(2):94-95.

Other genes implicated (Data extracted from papers in the Atlas) [ 8 ]


Translocations implicated (Data extracted from papers in the Atlas)

 t(2;5)(p23;q35) NPM1/ALK

External links

NPM1 (5q35.1) ALK (2p23.2)

NPM1 (5q35.1) ALK (2p23.2)

NPM1 (5q35.1) ALK (2p23.2)

Mitelman databaset(2;5)(p23;q35)
arrayMap (UZH-SIB Zurich)[select an item]
COSMIC_fusionNPM1/ALK NPM1 (5q35.1) ALK (2p23.2)   [fusion198]   [fusion199]   [fusion200]   [fusion201]   [fusion420]   [fusion448]   [fusion449]   [fusion450]   [fusion451]   [fusion452]   [fusion453]   [fusion454]   [fusion455]   [fusion456]   [fusion457]   [fusion458]  
Mitelman databaseNPM1::ALK [MCList]  NPM1 (5q35.1) ALK (2p23.2)
REVIEW articlesautomatic search in PubMed
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