Acute lymphoblastic leukemia (ALL) with KMT2A gene rearrangement in infants - characteristic clinical picture based on a case report
DOI:
https://doi.org/10.12775/JEHS.2022.12.03.022Keywords
leukemia, infant, all, KMT2AAbstract
The most common malignancy affecting children is leukemia, which in infants refers to be diagnosed before 1 year of age and is relatively rare, but remains a problem for clinicians due to its aggressive clinical presentation, poor response to current treatments, and molecular biology. Infants with acute leukemia tend to present with aggressive features, including hyperleukocytosis, hepatosplenomegaly, central nervous system (CNS) involvement, and cutaneous infiltration. In infant leukemia, the KMT2A gene rearrangement at chromosome 11q23 is quite common. Infants diagnosed with acute leukemia harboring a 11q23 rearrangement have a particularly poor prognosis when compared to other children with acute leukemia.
A 10-month-old girl was admitted in December 2017 to the Department of Pediatric Hematology, Oncology and Transplantology in Lublin with the suspicion of leukemia. One week before hospitalization minor bruises began to appear on the skin, unrelated to an injury. The child was admitted to the hospital, and there a complete blood count showed anemia, hiperleukocytosis and thorombocytopenia. On the admission to the Clinic: the severe general condition of the patient, with features of cardiopulmonary insufficiency were confirmed. Due to the patient's age and the presence of the KMT2A/MLLT3-t(9;11) (p22;q23) gene rearrangement, the infant was stratified as a high-risk group (HRG) and chemotherapy was started in accordance with the therapeutic program.
Infant leukemia is one of the most difficult clinical situations encountered in pediatric oncology. Given the infant’s vulnerability and unique genetic rearrangements, there is a need to develop new protocols and therapies for infants.
References
Brown P, Pieters R, Biondi A. How I treat infant leukemia. Blood. 2019, 133(3):205-214.
Emerenciano M, Koifman S, Pombo-de-Oliveira MS. Acute leukemia in early childhood. Braz J Med Biol 2007, 40(6):749-60.
Zweidler-McKay PA, Hilden JM. The ABCs of infant leukemia. Curr Probl Pediatr Adolesc Health Care. 2008, 38(3):78-94.
Seth R, Singh A. Leukemias in Children. Indian J Pediatr. 2015. 817-24.
Schrappe M. Treatment Protocol for Children and Adolescents With Acute Lymphoblastic Leukemia - AIEOP-BFM ALL 2017 https://clinicaltrials.gov/ct2/show/NCT03643276 (dostęp 2022.03.29)
Lee, S, Li, Z, Tai, S. T., Oh, B, & Yeoh, A. Genetic Alterations in Childhood Acute Lymphoblastic Leukemia: Interactions with Clinical Features and Treatment Response. Cancers, 2021 13(16), 4068.
Wertheim G. Infant Acute Leukemia. Clinics in laboratory medicine, 41(3), 2021, 541–550.
Inaba H, & Mullighan, C. G. Pediatric acute lymphoblastic leukemia. Haematologica, 2020, 105(11), 2524–2539.
Roberts I, Nicholas J, Fordham. Neonatal leukaemia. Haematologica, 2018, 182(2):170-184.
Heikinheimo, M, Pakkala, S, Juvonen E. & Saarinen U.M. Immuno- and cytochemical characterization of congenital leukemia: a case report. Medical and Pediatric Oncology, 1994, 22, 279– 282.
Pieters R, Schrappe M. A treatment protocol for infants younger than 1 year with acute lymphoblastic leukaemia (Interfant-99): an observational study and a multicentre randomised trial, Lancet, 2007, 370(9583):240-250.
Bresters D, Reus ACW, Veeman AJP. Congenital leukaemia: The Dutch experience and review of the literature. Br J Haematol 2002; 117: 513–524.
Mariko Eguchi. „Acute leukemia of infants and neonates”, Ketsueki actions, 2021;62(8):1308-1318.
Dreyer ZE, Hilden JM, Jones TL. Intensified chemotherapy without SCT in infant ALL: results from COG P9407 (Cohort 3). Pediatr Blood Cancer 2015; 62:419–426
R Pieters, M Schrappe, P De Lorenzo. A treatment protocol for infants younger than 1 year with acute lymphoblastic leukaemia (Interfant-99): an observational study and a multicentre randomised trial, Lancet, 2007, 370 (9583), pp. 240-250
Pieters, Rob. “Outcome of Infants Younger Than 1 Year With Acute Lymphoblastic Leukemia Treated With the Interfant-06 Protocol: Results From an International Phase III Randomized Study.” Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2019, vol. 37,25.
Salzer, Wanda L.“Modifications to induction therapy decrease risk of early death in infants with acute lymphoblastic leukemia treated on Children's Oncology Group P9407.” Pediatric blood & cancer 2012, vol. 59,5: 834-9.
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