t(11;16)(q23;p13)/KMT2A-CREBBP in hematologic malignancies: presumptive evidence of myelodysplasia or therapy-related neoplasm?

Ann Hematol. 2020 Mar;99(3):487-500. doi: 10.1007/s00277-020-03909-7. Epub 2020 Jan 31.

Abstract

Fusion partners of KMT2A affect disease phenotype and influence the current World Health Organization classification of hematologic neoplasms. The t(11;16)(q23;p13)/KMT2A-CREBBP is considered presumptive evidence of a myelodysplastic syndrome (MDS) and a MDS-related cytogenetic abnormality in the classification of acute myeloid leukemia (AML). Here, we report 18 cases of hematologic neoplasms with t(11;16). There were 8 males and 10 females with a median age of 51.9 years at time of detection of t(11;16). Of 17 patients with enough clinical information and pathological materials for review, 16 had a history of cytotoxic therapies for various malignancies including 12/15 patients who received topoisomerase II inhibitors, and 15 were classified as having therapy-related neoplasms. The median interval from the diagnosis of primary malignancy to the detection of t(11;16) was 23.2 months. Dysplasia, usually mild, was observed in 7/17 patients. Blasts demonstrated monocytic differentiation in 8/8 patients who developed AML at the time or following detection of t(11;16). t(11;16) was observed as the sole chromosomal abnormality in 10/18 patients. KMT2A rearrangement was confirmed in 11/11 patients. The median survival from the detection of t(11;16) was 15.4 months. In summary, t(11;16)(q23;p13) is rare and overwhelmingly associated with prior exposure of cytotoxic therapy. Instead of being considered presumptive evidence of myelodysplasia, we suggest that the detection of t(11;16) should automatically prompt a search for a history of malignancy and cytotoxic therapy so that proper risk stratification and clinical management are made accordingly. The dismal outcome of patients with t(11;16) is in keeping with that of therapy-related neoplasms.

Keywords: Acute myeloid leukemia; KMT2A-CREBBP; Myelodysplastic syndrome; Therapy-related; t(11;16)(q23;p13).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • CREB-Binding Protein / genetics*
  • Chromosomes, Human, Pair 11 / genetics*
  • Chromosomes, Human, Pair 16 / genetics*
  • Databases, Factual*
  • Female
  • Hematologic Neoplasms* / drug therapy
  • Hematologic Neoplasms* / genetics
  • Hematologic Neoplasms* / mortality
  • Histone-Lysine N-Methyltransferase / genetics*
  • Humans
  • Leukemia, Myeloid, Acute* / drug therapy
  • Leukemia, Myeloid, Acute* / genetics
  • Leukemia, Myeloid, Acute* / mortality
  • Male
  • Middle Aged
  • Myelodysplastic Syndromes* / drug therapy
  • Myelodysplastic Syndromes* / genetics
  • Myelodysplastic Syndromes* / mortality
  • Myeloid-Lymphoid Leukemia Protein / genetics*
  • Neoplasms, Second Primary* / drug therapy
  • Neoplasms, Second Primary* / genetics
  • Neoplasms, Second Primary* / mortality
  • Oncogene Proteins, Fusion / genetics*
  • Risk Assessment
  • Topoisomerase II Inhibitors / administration & dosage*
  • Translocation, Genetic*

Substances

  • KMT2A protein, human
  • Oncogene Proteins, Fusion
  • Topoisomerase II Inhibitors
  • Myeloid-Lymphoid Leukemia Protein
  • Histone-Lysine N-Methyltransferase
  • CREB-Binding Protein
  • CREBBP protein, human