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Cytogenetic Analysis in
Hematological Malignancies
Hwei-Fang Tien, National Taiwan
University Hospital
Recurrent chromosomal abnormalities in
Hematological malignancies
Abnormalities important for classification
CML t(9;22)
AML t(8;21), t(15;17), inv(16), t(9;11), inv(3),
t(6;9), t(1;22), -5/5q-, -7/7q-
ALL t(4;11), t(1;19), t(v;11q23), t(12;21)*
MDS -Y, del(11q); del(5q), del(12p), del(20q);
del(7q), +8, +19, i(17q); -7, inv(3)
Lymphoma
DLBCL t(3q27)
Burkitt t(8;14) and variant
Follicular t(14;18)
Mantle cell t(11;14)
Marginal zone t(11;18), t(1;14), t(14;18)
Purpose of Cytogenetic Study in
Hematological malignancies
1. Diagnosis and classification
2. Risk stratification
3. Selection of proper treatment
4. Follow-up of the response
Case Demonstration
Diagnosis
BM smears in a patient with
thrombocytopenia and anemia
NTUH, Gene Chromosome Cancer, 1995,12:161
Cytogenetic Abnormalities
NTUH, Gene Chromosome Cancer, 1995,12:161
Final dignosis: hepatosplenic Tγ/δ lymphoma
Large granular lymphocytosis
Br J Haematol, 1998, 103:1124
Cytogenetic Abnormalities
Diagnosis: NK-cell large granular lymphocyte leukemia
PB smears
BM aspirate smears from a patient
with pancytopenia
Hypoplastic MDS
Name: 林X榮,
46, XY, -7 [20]
Chromosomal abnormality
Diagnosis: hypoplastic MDS
Leukemia, 2008, 22:544
Case Demonstration
For Lymphoma Staging
BM study for staging in a patients with DLBCL
BM biopsy: no lymphoma involvement
BM smears
Same Clonal Chromosomal Abnormalities
in Lymph Node as in Bone Marrow
Lymph node Bone marrow
Lymphoma involvement of BM is confirmed
Risk Stratification
Impact of Cytogenetics in AML based on
2008 WHO Classification
Medical Research Council , United Kingdom
Blood. 2010;116(3):354 , Blood Rev, 2011; 25:39
t(9;22)
-7/7q-
-5/5q-
Inv(3), t(3;3)
t(9;11)
t(3;5)
t(6;9)
MDS-related
other t(11q23)
t(15;17)
t(8;21)
Inv(16)
5876 patients
Normal
Cytogenetic Scoring System in MDS (n=2,754)
Abnormality Overall
survival
AML
transformation
Prognostic
Subgroup
No.
of
Pts
% Single Double Cplx Median
(months)
Median
(months)
Very good 81 2.9 del(11q), -Y ―
―
60.8 NR
Good
(reference)
1,809 65.7 Normal, del(5q)
del(12p), del(20q)
Including
del(5q) ―
48.6 NR
Intermediate 529 19.2 del(7q), +8, i(17q)
+19, any other
Independent
clones
Any other
―
26.0 78.0
Poor 148 5.4 Inv(3)/t(3q)/del(3q),
-7
Including
-7/del(7q)
3 15.8 21.0
Very poor 187 6.8 ― ― > 3 5.9 8.2
Abbreviations: AML, acute myeloid leukemia; NR, not reached.
Schanz et al, J Clin Oncol, 2012
MM: Impact of genomic aberrations on OS
Blood. 2007;109:3489
Prognostic relevance of chromosome aberrations in CLL
Best Pract Res Clin Haematol. 2007 20:439
17p-
11q-
+12
13q- sole
normal
Follow Up the Clinical Course
Chronic Myeloid Leukemia, Chronic Phase
CML in acute transformation
Indication of Cytogenetic Study
• Unknown cause of cytopenia
• Fever of unknown origin
• WHO classification of AML and ALL
• MDS diagnosis, classification (IPSS, IPSS-R)
• Lymphoma diagnosis, classification and
staging work up
• Risk stratification of CLL and MM
• Follow-up of treatment response
台灣藍鵲( Formosan Blue Magpie )

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Cytogenetic analysis in Hematological Malignancies

  • 1. Cytogenetic Analysis in Hematological Malignancies Hwei-Fang Tien, National Taiwan University Hospital
  • 2. Recurrent chromosomal abnormalities in Hematological malignancies Abnormalities important for classification CML t(9;22) AML t(8;21), t(15;17), inv(16), t(9;11), inv(3), t(6;9), t(1;22), -5/5q-, -7/7q- ALL t(4;11), t(1;19), t(v;11q23), t(12;21)* MDS -Y, del(11q); del(5q), del(12p), del(20q); del(7q), +8, +19, i(17q); -7, inv(3) Lymphoma DLBCL t(3q27) Burkitt t(8;14) and variant Follicular t(14;18) Mantle cell t(11;14) Marginal zone t(11;18), t(1;14), t(14;18)
  • 3. Purpose of Cytogenetic Study in Hematological malignancies 1. Diagnosis and classification 2. Risk stratification 3. Selection of proper treatment 4. Follow-up of the response
  • 5. BM smears in a patient with thrombocytopenia and anemia NTUH, Gene Chromosome Cancer, 1995,12:161
  • 6.
  • 7. Cytogenetic Abnormalities NTUH, Gene Chromosome Cancer, 1995,12:161 Final dignosis: hepatosplenic Tγ/δ lymphoma
  • 8. Large granular lymphocytosis Br J Haematol, 1998, 103:1124 Cytogenetic Abnormalities Diagnosis: NK-cell large granular lymphocyte leukemia PB smears
  • 9. BM aspirate smears from a patient with pancytopenia
  • 11. Name: 林X榮, 46, XY, -7 [20] Chromosomal abnormality Diagnosis: hypoplastic MDS Leukemia, 2008, 22:544
  • 13. BM study for staging in a patients with DLBCL BM biopsy: no lymphoma involvement BM smears
  • 14.
  • 15. Same Clonal Chromosomal Abnormalities in Lymph Node as in Bone Marrow Lymph node Bone marrow Lymphoma involvement of BM is confirmed
  • 17. Impact of Cytogenetics in AML based on 2008 WHO Classification Medical Research Council , United Kingdom Blood. 2010;116(3):354 , Blood Rev, 2011; 25:39 t(9;22) -7/7q- -5/5q- Inv(3), t(3;3) t(9;11) t(3;5) t(6;9) MDS-related other t(11q23) t(15;17) t(8;21) Inv(16) 5876 patients Normal
  • 18. Cytogenetic Scoring System in MDS (n=2,754) Abnormality Overall survival AML transformation Prognostic Subgroup No. of Pts % Single Double Cplx Median (months) Median (months) Very good 81 2.9 del(11q), -Y ― ― 60.8 NR Good (reference) 1,809 65.7 Normal, del(5q) del(12p), del(20q) Including del(5q) ― 48.6 NR Intermediate 529 19.2 del(7q), +8, i(17q) +19, any other Independent clones Any other ― 26.0 78.0 Poor 148 5.4 Inv(3)/t(3q)/del(3q), -7 Including -7/del(7q) 3 15.8 21.0 Very poor 187 6.8 ― ― > 3 5.9 8.2 Abbreviations: AML, acute myeloid leukemia; NR, not reached. Schanz et al, J Clin Oncol, 2012
  • 19. MM: Impact of genomic aberrations on OS Blood. 2007;109:3489
  • 20. Prognostic relevance of chromosome aberrations in CLL Best Pract Res Clin Haematol. 2007 20:439 17p- 11q- +12 13q- sole normal
  • 21. Follow Up the Clinical Course
  • 22. Chronic Myeloid Leukemia, Chronic Phase
  • 23. CML in acute transformation
  • 24. Indication of Cytogenetic Study • Unknown cause of cytopenia • Fever of unknown origin • WHO classification of AML and ALL • MDS diagnosis, classification (IPSS, IPSS-R) • Lymphoma diagnosis, classification and staging work up • Risk stratification of CLL and MM • Follow-up of treatment response