Acute megakaryoblastic leukemia (AMegL)
M7 acute myeloid leukemia (M7-AML)

2003-11-01   Francesco Cavazzini , Gianluigi Castoldi , Antonio Cuneo 

1.Hematology Section, Dept. Of Biomedical Sciences, University of Ferrara, 44100 Ferrara Italy

Clinics and Pathology

Phenotype stem cell origin

This leukemia is thought to derive from the transformation of a multipotent myeloid progenitor cell. In the adult patient multilineage dysplasia is a common finding and in some cases a minority of myeloid blast cells is present.
The blast cells show one or more megakaryocytic markers (i.e. Factor VIII, CD61, CD41, or CD42), they test negative when using the anti-myeloperoxidase monoclonal antibody and never show coordinated expression of lymphoid markers, though isolated CD2 or CD7 positivity can be found on some occasions. The CD34, CD13 and CD33 markers are positive in a substantial fraction of cases, as is the case with the CD36/thrombospondin receptor.
The myeloperoxidase stain is negative by light microscopy, but ultrastructural peroxidase activity with a specific peri-nuclear staining pattern can be detected at the electron microscopy level.

Epidemiology

The disease is rare and, due to difficulty in diagnosis, its exact incidence is not known. Reasonably, it may account for approximately 1-2% of all de novo acute myeloid leukemias (AML) in the adult population, but the incidence in the pediatric age group is higher, partly due to an association with Down syndrome.

Clinics

The presentation is usually acute, though AMegL may develop after myelodysplastic syndrome or chronic myelogenous leukemia (CML).
In some cases acute myelofibrosis is the presentation picture.
AMegL should be distinguished from AML with megakaryoblastic involvement showing a minority of megakaryoblasts.
In children there is an association with Down syndrome.

Cytology

The blast cell morphology varies from case to case. In some patients the blasts are undifferentiated and the diagnosis requires immunophenotyping or electron microscopy studies. Dysmegakaryocytopoiesis is rather frequent. Other patients may show bleb-forming blasts, but this feature is nor specific for megakaryoblasts. Micromegakaryocytes can be frequently seen.

Pathology

The bone biopsy almost invariably shows fibrosis, which can be extensive in up to 75% of the cases.
Spleen enlargement is frequently seen in children, less frequently in adults.

Treatment

Myeloablative treatment followed, whenever possible, by allogeneic or autologous bone marrow transplant is the treatment of choice

Prognosis

In general, the prognosis is severe. 30-to-50 % of the adult patients achieve a complete morphologic remission, but the majority relapse within a few months. Median duration of CR and survival in a study was 10.6 months and 10.4 months, respectively. Some children may fare better, with a 50% 3-year event free survival in AML-M7 post Down Syndrome or with the t(1;22) (see below). Prognosis is dismal in children with other cytogenetic abnormalities.

Cytogenetics

Cytogenetics morphological

a) Adults
There is no cytogenetic anomaly that is specific for AML-M7. The karyotype is abnormal in the vast majority of cases with complex aberrations (i.e. 3 or more clonal aberrations) occurring more frequently than in other AMLs. -5/5q- and/or -7/7q+ are found, as a rule, in virtually all cases with complex karyotype, which globally account for 70-80% of abnormal cases.
3q21 or q26 aberrations are found in 20-30% of the cases; the t(9;22) is another recurrent chromosome aberrations in de novo AML-M7.
Trisomy 19 and 21 may occur in de novo as well as in secondary AML-M7. They are the most frequently occurring chromosome gains and they may be associated with any of the cytogenetic group listed above.

b) Children
The t(1;22)(p13;q13) is specifically associated with children AML-M7, being found in approximately half of the cases. The remaining patients may show +21 (irrespective of the association with Down syndrome), +19, +8. The karyotype may be normal in approximately 10% of the cases.

Cytogenetics molecular

Partial trisomy 19, involving the q13 band, can be shown to occur at a 20-30% incidence by comparative genomic hybridization
The t(1;22)(p13;q13) fuses the OTT(RBM15) gene on 1p13 to the MAL(MKL1) gene on chromosome 22, leading to the OTT-MAL fusion gene on the derivative 22

Genes Involved and Proteins

Gene name
RBM15 (RNA binding motif protein 15)
Location
1p13.3
Gene name
MKL1 (megakaryoblastic leukemia (translocation) 1)
Location
22q13.1

Result of the Chromosomal Anomaly

Note

The fusion gene OTT-MAL is on the der(22) chromosome and contains almost all of the sequences of each gene.

Bibliography

Pubmed IDLast YearTitleAuthors
115794692001Frequent gain of chromosome 19 in megakaryoblastic leukemias detected by comparative genomic hybridization.Alvarez S et al
2013181978Megakaryoblastic acute leukemia: identification by the ultrastructural demonstration of platelet peroxidase.Breton-Gorius J et al
27902021989Multipotent stem cell involvement in megakaryoblastic leukemia: cytologic and cytogenetic evidence in 15 patients.Cuneo A et al
120913562002Cytogenetic profile of childhood and adult megakaryoblastic leukemia (M7): a study of the Groupe Français de Cytogénétique Hématologique (GFCH).Dastugue N et al
126911422003Acute megakaryoblastic leukaemia: a national clinical and biological study of 53 adult and childhood cases by the Groupe Français d'Hématologie Cellulaire (GFHC).Duchayne E et al
114316912001Fusion of two novel genes, RBM15 and MKL1, in the t(1;22)(p13;q13) of acute megakaryoblastic leukemia.Ma Z et al
113443112001Involvement of a human gene related to the Drosophila spen gene in the recurrent t(1;22) translocation of acute megakaryocytic leukemia.Mercher T et al
124113272002Chromosome 19 abnormalities are commonly seen in AML, M7.Nimer SD et al
31652921988Leukemias with megakaryoblastic involvement: clinical, hematologic, and immunologic characteristics.San Miguel JF et al
110018912000Acute megakaryocytic leukemia: the Eastern Cooperative Oncology Group experience.Tallman MS et al
29789611987Megakaryoblastic leukemia and Down's syndrome: a review.Zipursky A et al

Summary

Note

Sometimes presenting as "acute myelofibrosis"

Citation

Francesco Cavazzini ; Gianluigi Castoldi ; Antonio Cuneo

Acute megakaryoblastic leukemia (AMegL)
M7 acute myeloid leukemia (M7-AML)

Atlas Genet Cytogenet Oncol Haematol. 2003-11-01

Online version: http://atlasgeneticsoncology.org/haematological/1100/acute-megakaryoblastic-leukemia-(amegl)-br-m7-acute-myeloid-leukemia-(m7-aml)

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