Clinicopathologic and molecular characterization of myeloid neoplasms with isolated t(6;9)(p23;q34)

Abstract

Introduction: The t(6;9)(p23;q34);DEK-NUP214 [t(6;9)] abnormality is found in 0.7-1.8% of patients with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). FLT3-ITD mutations are detected in t(6;9) patients. The t(6;9) abnormality is associated with poor outcomes. We studied the clinicopathologic and molecular profiles of patients with AML/MDS carrying t(6;9).

Methods: We collected clinical data of nine patients with AML/MDS with isolated t(6;9) (median age = 41 years; male/female = 4/5) and genotyped DNAs using whole exome, Sanger, and targeted sequencing.

Results: Our cohort was characterized by frequent multilineage dysplasia (56%), absence of phospho-STAT3/STAT5 expression, presence of myeloid markers (CD13, CD33, CD34, CD117, HLA-DR) with an aberrant expression of CD7, and poor outcome (median survival of 20 months). Although basophilia has been described in association with t(6;9), we observed lack of marrow basophilia in our cohort. Molecularly, 83% (5/6) of patients with AML/MDS with t(6;9) were characterized by at least one somatic mutation. Among them, four patients showed multiple mutations. FLT3-ITD mutations were detected in 33% of patients (2/6); 80% (4/5) of mutant patients died even after hematopoietic stem cell transplantation.

Conclusion: Our data demonstrated that AML/MDS patients with t(6;9) have diverse molecular mutations regardless of the presence of FLT3 mutations, which may contribute to their poor survival outcomes.

Keywords: AML; MDS; t(6;9)(p23;q34).

Figure 1.

Morphologic features of a patient with AML MRC and t(6;9) carrying CUX1 and KDM6A. Bone marrow aspirate smear (Wright–Giemsa stain, ×500) from a 39-year-old patient with a diagnosis of AML MRC shows increased blasts with dysgranulopoiesis, dyserythropoiesis, and dysmegakaryopoiesis. Inlet highlights dysplastic megakaryocytes. Red arrow indicates a basophil. Patient corresponds to #3 in Table II. The patient received chemotherapy with no response and expired soon after. Patient carried CUX1 and KDM6A mutations.

Figure 2.

Morphologic features of a patient with AMMoL and t(6;9) carrying FLT3-ITD and WT1. Bone marrow aspirate smear (Wright–Giemsa stain, ×500) derived from a 49-year-old patient with AMMoL shows significantly increased myeloblasts/monoblasts and lack of basophils. Patient corresponds to #4 in Table 2. Patient relapsed after chemotherapy and expired 15 months later. Patient carried FLT3 and WT1 mutations.