Paediatric B lymphoblastic leukaemia with hyperdiploidy and a false-positive KMT2A fluorescence in situ hybridization result

Jenna Nunn, Nandini Adayapalam, Sarbjit Riyat, Louise Seymour, Bronwyn Williams, Jacqueline Rehn, Deborah White, Andrew S. Moore, Karen Tsuchiya

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

The dramatic improvement in the event-free survival of paediatric B-lymphoblastic leukaemia (B-ALL) has led to risk-stratified treatment. Through a combination of clinical features, cytogenetic abnormalities and assessment of treatment response, patients are stratified to receive different intensities of therapy. The presence of high hyperdiploidy (>50 chromosomes) is considered a favourable genetic feature. Conversely, KMT2A fusion genes in B-ALL are associated with a poor prognosis, resulting in intensification of treatment. We present a seven-year-old female with B-ALL, a high hyperdiploid karyotype (56 chromosomes) and KMT2A rearrangement detected on FISH, but with no productive fusion identified. Single nucleotide polymorphism (SNP) array suggested the KMT2A rearrangement was due to chromosome 11 chromothripsis. Subsequent targeted RNA fusion panel and whole transcriptomic sequencing (mRNA-seq) did not detect an expressed KMT2A fusion. Differential expression analyses of the mRNA-seq data led to clustering of this case with other hyperdiploid cases, consistent with the hyperdiploid cytogenetic results. Given the additional intensity and potential toxicity of high-risk treatment, unusual findings by chromosome analysis, FISH and/or chromosomal microarray should prompt consideration of testing for a KMT2A fusion by another method to avoid misclassification.

Original languageEnglish
Pages (from-to)80-83
Number of pages4
JournalCancer Genetics
Volume278-279
DOIs
Publication statusPublished or Issued - Nov 2023

Keywords

  • B-ALL
  • FISH
  • Hyperdiploid
  • KMT2A
  • RNA-seq

ASJC Scopus subject areas

  • Molecular Biology
  • Genetics
  • Cancer Research

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