2019-04-01   Mary J Underdown , Mary J Underdown , Mary J Underdown , Mary J Underdown 

1.Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina (MJU); Section of Pediatric Hematology-Oncology, Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina (DEK, TBR); Department of Pathology, Wake Forest School of Medicine, Winston Salem, USA (MJP), Medical Center Boulevard, Winston Salem, NC, USA 27157; dkram@wakehealth.edu
2.Childrens Cancer Research Institute, Kinderspitalgasse 6, A-1090 Vienna, Austria


Dicentric (7;9)(p11-13;p11) is a rare but recurrent abnormality in pediatric and adult precursor B acute lymphoblastic leukemia (B-ALL). The rarity precludes a deep understanding of its biology and associated prognosis. However, recent findings have correlated dic(7;9) and PAX5 mutations, highlighting this cytogenetic events involvement in leukemogenesis and may also shed light on the overall prognosis of dic(7;9) B-ALL.

Clinics and Pathology



Phenotype stem cell origin

FAB L1 phenotype; pre-B immunophenotype, cIg+ or cIg-


There have been 36 cases of dic(7;9)(p11-13;p11) currently identified in the literature, 17 (47.2%) of which are pediatric cases. This rare translocation makes up < 1% of childhood ALL, It is most commonly found in younger children, age ≤ 6 years; dic(7;9)(p11-13;p11) is found in approximately 3% of childhood ALL with 9p abnormalities and has been associated with B-ALL with t(9;22), or Philadelphia chromosome positive ALL.


The most common clinical manifestations of dic(7;9) noted in the literature include age female, T- and B-ALL with B-cell predominance, leukocytosis


Favorable prognostic indicators in ALL include: age 1-10 years, female sex, Caucasian or Asian ethnicity, WBC count



Several dicentric chromosomes found in childhood ALL are formed from the q arms of chromosomes 7, 9, 12, and, 17 with partial loss of the respective p arms.
Atlas Image
Figure 2: FISH image depicting 7; dic 7-9; 9 with centromeric probes of 7 and 9 fused - Courtesy Department of Pathology, Wake Forest School of Medicine, Winston Salem, USA.

Cytogenetics morphological

Unbalanced; In most cases, formation of a dicentric chromosome resulting in partial monosomies of 7p and 9p -> hypodiploid with 45 chromosomes. However, hyperdiploidy (56 chromosomes) has been identified.

Additional anomalies

del(6q), dup(1p), del(8p),...

Genes Involved and Proteins

Genes involved are unknown.
Gene name
Recent studies have shown an association between dic(7;9) and PAX5 mutation. PAX5 encodes the B lymphoid transcription factor gene and is vitally important in regulating B cell lineage differentiation. PAX5 alterations may lead to arrested B-cell development in the pro-B-cell stage and may be central events in B lymphoid leukemogenesis (Shah and Schrader, 2013).
A recent study by Bastian, et. al. found 19/250 pediatric and adult patients with B-cell precursor ALL harbored PAX5 mutations. Of these patients with PAX5 mutations, 12/19 (63%) had alterations in chromosome 9, though the specific cytogenetic alterations were not reported (Bastian and Schroeder, 2019).
A large cohort study out of St. Judes identified 17/1988 (0.86%) patients with dic(7;9) translocation; of those, 11/17 (65%) had a PAX5 alteration or mutation. While the PAX5 gene is located on 9p13.2, 5/11 (45%) cases with dic(7;9)(p11;p11) were associated with PAX5 alterations. This study found two distinct subtypes of B-ALL characterized by PAX5 alterations: the first (n=148) which harbor diverse PAX5 alterations (including rearrangements, sequence mutations, and focal intragenic amplifications) and the second (n=44) which harbor a particular nonsilent sequence mutation, PAX5 p.Pro80Arg. As a group of all PAX5, the 5-year event-free survival was variable, ranging from 50% to 75% (Gu and Churchman, 2019).


Pubmed IDLast YearTitleAuthors
84183691993Collaborative study of karyotypes in childhood acute lymphoblastic leukemias. Groupe Français de Cytogénétique Hématologique.
308426092019PAX5 biallelic genomic alterations define a novel subgroup of B-cell precursor acute lymphoblastic leukemia.Bastian L et al
22944361990Deletions of interferon genes in acute lymphoblastic leukemia.Diaz MO et al
306432492019PAX5-driven subtypes of B-progenitor acute lymphoblastic leukemia.Gu Z et al
149992942004Deletion of 7p or monosomy 7 in pediatric acute lymphoblastic leukemia is an adverse prognostic factor: a report from the Children's Cancer Group.Heerema NA et al
264659872015Acute Lymphoblastic Leukemia in Children.Hunger SP et al
282976282017Genetic Basis of Acute Lymphoblastic Leukemia.Iacobucci I et al
273419962016Chromosomal aberrations in childhood acute lymphoblastic leukemia: 15-year single center experience.Jarosova M et al
111068132000Screening for specific chromosome involvement in hematological malignancies using a set of seven chromosome painting probes. An alternative approach for chromosome analysis using standard FISH instrumentation.Nacheva EP et al
169385752006Dicentric (7;9)(p11;p11) is a rare but recurrent abnormality in acute lymphoblastic leukemia: a study of 7 cases.Pan J et al
146692942003Reassessment of the prognostic significance of hypodiploidy in pediatric patients with acute lymphoblastic leukemia.Raimondi SC et al
240136382013A recurrent germline PAX5 mutation confers susceptibility to pre-B cell acute lymphoblastic leukemia.Shah S et al
113433782001Acute lymphoblastic leukemia in the elderly: The Edouard Herriot Hospital experience.Thomas X et al
98066641998Clinical significance of Philadelphia chromosome positive pediatric acute lymphoblastic leukemia in the context of contemporary intensive therapies: a report from the Children's Cancer Group.Uckun FM et al
95950401998Detection of chromosome over- and underrepresentations in hyperdiploid acute lymphoblastic leukemia by comparative genomic hybridization.Wong N et al


Atlas Image
Figure 1: dic(7;9)(p11-13;p11) G-banding - Courtesy Cytogenetics Laboratory of the CCRI, Childrens Cancer Research Institute, Vienna.


Mary J Underdown ; Mary J Underdown ; Mary J Underdown ; Mary J Underdown


Atlas Genet Cytogenet Oncol Haematol. 2019-04-01

Online version: http://atlasgeneticsoncology.org/haematological/1054/dic(7;9)(p11-13;p11)

Historical Card

2005-09-01 dic(7;9)(p11-13;p11) by  Sabine Strehl 

Childrens Cancer Research Institute, Kinderspitalgasse 6, A-1090 Vienna, Austria