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t(11;17)(q23;q21) ZBTB16/RARA

Written1998-04Franck Viguié
Laboratoire de Cytogenetique - Service d'Hematologie Biologique, Hopital Hotel-Dieu - 75181 Paris Cedex 04, France

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ICD-Morpho 9861/3 AML with mutated NPM1; AML with mutated CEBPA; Acute myeloid leukaemia, NOS
Atlas_Id 1028
  t(11;17)(q23;q21) G- banding - Courtesy Diane H. Norback, Eric B. Johnson, Sara Morrison-Delap UW Cytogenetic Services .

Clinics and Pathology

Disease specifically observed in acute promyelocytic leukemia (APL), or M3 AML; in the vast majority of cases, M3 AML is characterized by a t(15;17)(q25;q21); the t(11;17) represents a rare variant translocation with characteristic clinicopathologic features concerning presentation, response to treatment with all-trans retinoic acid (ATRA) and prognosis.
Phenotype / cell stem origin promyelocytic (M3) acute leukaemia; a number of patients express an unusual morphologic spectrum intermediate between M2 and M3 AML.
Epidemiology less than 1% of morphologic M3 AML.
Clinics high incidence at diagnosis of disseminated intravascular coagulation; poor response to ATRA at induction therapy, in contrast with the classical M3 AML with t(15;17).
Cytology high rate of normal or dystrophic promyelocytes in peripheral blood and in bone marrow; no intracytoplasmic Auer rods; myeloperoxydase reaction positive; immunocytochemical detection with an anti-PLZF shows a distinct punctate nuclear distribution of the protein, suggesting its compartmentalization in the nucleus.
In patients with t(11;17)(q23;q21), t(5;17)(q35;q21), and t(11;17)(q13;q21) where RARa is fused to the PLZF (promyelocytic leukemia zinc finger), NPM (nucleophosmin) and NuMA (nuclear mitotic apparatus) genes respectively, chromosome 17 and RARa but not PML are involved. Patients were initially reported as having M3 morphology. Interestingly, the t(11;17)(q23;q21) PLZF/RARa subgroup showed a clearly morphological differences with predominance of cells with regular nuclei, many granules, usually no Auer rods, increased number of pseudo Pelger-Huet cells and a strong MPO activity. These particular characteristics could allow the definition of a separate morphological entity among APL. Patients with t(5;17)(q35;q21) are too rares to draw any morphological correlation - Text and iconography Courtesy Georges Flandrin 2001.
Prognosis distinctly worse prognosis than M3 AML with t(15;17), mainly because the patients fail to respond to the maturation effect of ATRA.


Cytogenetics Molecular fusion of distal PLZF probe with RARa on 17q21.
Additional anomalies no recurrent additional anomaly are known.
Variants 3 related translocations observed in M3 AML; the first is the common translocation (15;17) and the two others are extremelly rare; all these translocations involve a breakpoint at 17q21, in RARa, which fuses with different partners: 1- t(15;17)(q22;q21), fusion with PML in 15q22; 2- t(5;17)(q32;q12), fusion with NPM1 in 5q32, encoding for a RNA processing protein; 3- t(11;17)(q13;q21), fusion with NUMA in 11q13, involved in the control of mitosis.

Genes involved and Proteins

Gene NameZBTB16 (zinc finger and BTB domain containing 16)
Location 11q23.2
Dna / Rna Krüppel-like zinc finger gene.
Protein transcription factor associated with myeloid maturation.
Gene NameRARA (Retinoic acid receptor, alpha)
Location 17q21.2
Protein nuclear receptor with DNA binding and transcriptional properties.

Result of the chromosomal anomaly

Hybrid gene
Description the translocation involves a breakpoint in the zinc finger region of PLZF, with fusion of two zinc fingers to the RARa B region to form a 5' PLZF - 3' RARa fusion gene; the reciprocal 5' RARa - 3' PLZF gene fuses seven zinc fingers to the RARa region; RARa's breakpoint occurs in intron 2, as is in classical t(15;17)
Transcript both 5' PLZF -3' RARa and 5' RARa - 3' PLZF transcripts are detected by RT-PCR, and both fusion partners would be implicated in leukemogenesis; four chimeric transcripts are produced, due to alternative splicing of PLZF gene and to transcription of either A1 or A2 domain of RARa gene
Fusion Protein
Description 1- as a result of thealternative splicing of PLZF gene, two forms of PLZF-RARa protein can be detected: a) PLZF(A)-RARa (735 amino acids; 81 kDa) composed of the N-term part of PLZF including POZ domain and two of the nine zinc fingers, fused to the DNA and ligand binding domains of RARa b) PLZF(B)-RARa (858 amino acids; 93 kDa) differing from form A by the inclusion of a 123 amino acid prolin rich segment of PLZF; PLZF-RARa protein is an abnormal retinoic acid receptor with reduced and modified DNA-binding and transcriptional activities.
2- Two forms of RARa-PLZF protein are also detected, due to involvement of alternative promoters of the RARa gene: RARa(A1)-PLZF (277 amino acids; 31 kDa) and RARa(A2)-PLZF (274 amino acids; 31 kDa), composed of A1 or A2 transcriptional activation domain of RARa linked to the seven C-terminal zinc fingers of PLZF.


Variant and masked translocations in acute promyelocytic leukemia.
Brunel V, Lafage-Pochitaloff M, Alcalay M, Pelicci PG, Birg F
Leukemia & lymphoma. 1996 ; 22 (3-4) : 221-228.
PMID 8819070
Rearrangements of the retinoic acid receptor alpha and promyelocytic leukemia zinc finger genes resulting from t(11;17)(q23;q21) in a patient with acute promyelocytic leukemia.
Chen SJ, Zelent A, Tong JH, Yu HQ, Wang ZY, Derré J, Berger R, Waxman S, Chen Z
The Journal of clinical investigation. 1993 ; 91 (5) : 2260-2267.
PMID 8387545
Fusion between a novel Krüppel-like zinc finger gene and the retinoic acid receptor-alpha locus due to a variant t(11;17) translocation associated with acute promyelocytic leukaemia.
Chen Z, Brand NJ, Chen A, Chen SJ, Tong JH, Wang ZY, Waxman S, Zelent A
The EMBO journal. 1993 ; 12 (3) : 1161-1167.
PMID 8384553
Characterization of cryptic rearrangements and variant translocations in acute promyelocytic leukemia.
Grimwade D, Gorman P, Duprez E, Howe K, Langabeer S, Oliver F, Walker H, Culligan D, Waters J, Pomfret M, Goldstone A, Burnett A, Freemont P, Sheer D, Solomon E
Blood. 1997 ; 90 (12) : 4876-4885.
PMID 9389704
Clinical and molecular characterization of a rare syndrome of acute promyelocytic leukemia associated with translocation (11;17).
Licht JD, Chomienne C, Goy A, Chen A, Scott AA, Head DR, Michaux JL, Wu Y, DeBlasio A, Miller WH Jr
Blood. 1995 ; 85 (4) : 1083-1094.
PMID 7849296
A new variant translocation 11;17 in a patient with acute promyelocytic leukemia together with t(7;12).
Najfeld V, Scalise A, Troy K
Cancer genetics and cytogenetics. 1989 ; 43 (1) : 103-108.
PMID 2790765
PML, PLZF and NPM genes in the molecular pathogenesis of acute promyelocytic leukemia.
Pandolfi PP
Haematologica. 1996 ; 81 (5) : 472-482.
PMID 8952164


This paper should be referenced as such :
Viguié, F
Atlas Genet Cytogenet Oncol Haematol. 1998;2(3):97-99.
Free journal version : [ pdf ]   [ DOI ]
On line version :

Other genes implicated (Data extracted from papers in the Atlas) [ 6 ]


Translocations implicated (Data extracted from papers in the Atlas)

 t(11;17)(q23;q21) ZBTB16/RARA

External links

ZBTB16 (11q23.2) RARA (17q21.2)

ZBTB16 (11q23.2) RARA (17q21.2)

Mitelman databaset(11;17)(q23;q21)
arrayMap (UZH-SIB Zurich)Topo ( C42) Morph ( 9861/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
Mitelman databaseZBTB16/RARA [MCList]  ZBTB16 (11q23.2) RARA (17q21.2)
TICdbZBTB16/RARA  ZBTB16 (11q23.2) RARA (17q21.2)
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