CC BY 4.0 · Indian J Med Paediatr Oncol 2023; 44(06): 543-553
DOI: 10.1055/s-0043-1768052
Review Article

Role of Cytogenetics and Fluorescence In Situ Hybridization in the Laboratory Workup of Acute Myeloid Leukemias

1   Cancer Cytogenetics Department, Tata Memorial Centre, Advanced Centre for Research, Education and Treatment in Cancer (ACTREC), Kharghar, Navi Mumbai, India
,
1   Cancer Cytogenetics Department, Tata Memorial Centre, Advanced Centre for Research, Education and Treatment in Cancer (ACTREC), Kharghar, Navi Mumbai, India
2   Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, India
› Author Affiliations
Funding None.

Abstract

A new understanding of acute myeloid leukemia as a varied group of unique biologic entity has emerged, as a result of the identification of various chromosomal aberrations and their association with clinical prognosis and diagnosis. Following induction treatment, cytogenetic examination can establish the presence of any residual malignant cells, it's recurrence, clonal evolution if any, or the formation of novel abnormalities. The G-banded karyotype has been the gold standard method for detecting all of these aberrations for years. The capacity to examine the entire genome through karyotype analysis quickly enabled the detection of deletions, duplications, and structural rearrangements across every chromosome, and the more frequent ones were associated with particular aberrant clinical symptoms. Fluorescence in situ hybridization (FISH) is a sensitive technology that aids in differential diagnosis or therapeutic planning and provides rapid results. Furthermore, the combination of cytogenetic and molecular profiling enables a more precise evaluation of disease prognosis, diagnosis, classification, risk stratification, and patient treatment. Interphase FISH analysis, in conjunction with G-banded chromosomal analysis, can be used as a major testing tool for the evaluation of hematological neoplasms. For accurate and consistent descriptions of genomic changes identified by karyotyping and FISH, a specified terminology is necessary. The International System for Human Cytogenomic Nomenclature is the main source and provides instructions for documenting cytogenetic and molecular findings in laboratory reports. This review discusses the two methods, karyotyping and FISH, their advantages and limitations, sample requirements, various FISH probes that are used, nomenclature for results reporting, and the necessary quality control measures.

Authors' Contributions

H.J. was responsible for concept, design, definition of intellectual content, literature search, and manuscript preparation. D.S. was responsible for manuscript editing and manuscript review. The manuscript has been read and approved by all the authors, and the requirements for authorship have been met and each author believes that the manuscript represents honest work.


Supplementary Material



Publication History

Article published online:
27 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Döhner H, Weisdorf DJ, Bloomfield CD. Acute myeloid leukemia. N Engl J Med 2015; 373 (12) 1136-1152
  • 2 Sperling AS, Gibson CJ, Ebert BL. The genetics of myelodysplastic syndrome: from clonal haematopoiesis to secondary leukaemia. Nat Rev Cancer 2017; 17 (01) 5-19
  • 3 Barrett R, Morash B, Roback D. et al. FISH identifies a KAT6A/CREBBP fusion caused by a cryptic insertional t(8;16) in a case of spontaneously remitting congenital acute myeloid leukemia with a normal karyotype. Pediatr Blood Cancer 2017; 64 (08) DOI: 10.1002/pbc.26450.
  • 4 Grimwade D, Hills RK, Moorman AV. et al; National Cancer Research Institute Adult Leukaemia Working Group. Refinement of cytogenetic classification in acute myeloid leukemia: determination of prognostic significance of rare recurring chromosomal abnormalities among 5876 younger adult patients treated in the United Kingdom Medical Research Council trials. Blood 2010; 116 (03) 354-365
  • 5 Vardiman JW, Thiele J, Arber DA. et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 2009; 114 (05) 937-951
  • 6 Grimwade D, Walker H, Oliver F. et al; The Medical Research Council Adult and Children's Leukaemia Working Parties. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial. Blood 1998; 92 (07) 2322-2333
  • 7 Byrd JC, Mrózek K, Dodge RK. et al; Cancer and Leukemia Group B (CALGB 8461). Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia: results from Cancer and Leukemia Group B (CALGB 8461). Blood 2002; 100 (13) 4325-4336
  • 8 Slovak ML, Kopecky KJ, Cassileth PA. et al. Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group Study. Blood 2000; 96 (13) 4075-4083
  • 9 O'Donnell MR, Tallman MS, Abboud CN. et al. Acute Myeloid Leukemia, Version 3.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15 (07) 926-957
  • 10 Döhner H, Wei AH, Appelbaum FR. et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood 2022; 140 (12) 1345-1377
  • 11 Latagliata R, Avvisati G, Lo Coco F. et al. The role of all-trans-retinoic acid (ATRA) treatment in newly-diagnosed acute promyelocytic leukemia patients aged > 60 years. Ann Oncol 1997; 8 (12) 1273-1275
  • 12 Ablain J, de The H. Revisiting the differentiation paradigm in acute promyelocytic leukemia. Blood 2011; 117 (22) 5795-5802
  • 13 Grimwade D, Ivey A, Huntly BJ. Molecular landscape of acute myeloid leukemia in younger adults and its clinical relevance. Blood 2016; 127 (01) 29-41
  • 14 Ramos NR, Mo CC, Karp JE, Hourigan CS. Current approaches in the treatment of relapsed and refractory acute myeloid leukemia. J Clin Med 2015; 4 (04) 665-695
  • 15 Mardis ER, Ding L, Dooling DJ. et al. Recurring mutations found by sequencing an acute myeloid leukemia genome. N Engl J Med 2009; 361 (11) 1058-1066
  • 16 Sholl LM, Longtine J, Kuo FC. Molecular analysis of gene rearrangements and mutations in acute leukemias and myeloid neoplasms. Curr Protoc Hum Genet 2017; 92: 10.4.1-10.4.49
  • 17 Bennett JM, Catovsky D, Daniel MT. et al. Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group. Br J Haematol 1976; 33 (04) 451-458
  • 18 Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 2011; 117 (19) 5019-5032
  • 19 Arber DA, Orazi A, Hasserjian R. et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127 (20) 2391-2405
  • 20 Khoury JD, Solary E, Abla O. et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: myeloid and histiocytic/dendritic neoplasms. Leukemia 2022; 36 (07) 1703-1719
  • 21 Tallman MS, Wang ES, Altman JK. et al; OCN. Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17 (06) 721-749
  • 22 Mikhail FM, Heerema NA, Rao KW, Burnside RD, Cherry AM, Cooley LD. Section E6.1-6.4 of the ACMG technical standards and guidelines: chromosome studies of neoplastic blood and bone marrow-acquired chromosomal abnormalities. [published correction appears in Genet Med. 2016 Aug;18(8):859] Genet Med 2016; 18 (06) 635-642
  • 23 Seabright M. A rapid banding technique for human chromosomes. Lancet 1971; 2 (7731): 971-972
  • 24 Jean McGowan-Jordan. Sarah M, Hastings R. An International System for Human Cytogenomic Nomenclature; 2020
  • 25 Martens JH, Stunnenberg HG. The molecular signature of oncofusion proteins in acute myeloid leukemia. FEBS Lett 2010; 584 (12) 2662-2669
  • 26 Marceau-Renaut A, Duployez N, Ducourneau B. et al. Molecular profiling defines distinct prognostic subgroups in childhood AML: a report from the French ELAM02 Study Group. HemaSphere 2018; 2 (01) e31
  • 27 Fröhling S, Kayser S, Mayer C. et al; AML Study Group Ulm. Diagnostic value of fluorescence in situ hybridization for the detection of genomic aberrations in older patients with acute myeloid leukemia. Haematologica 2005; 90 (02) 194-199
  • 28 Kearney L. Molecular cytogenetics. Best Pract Res Clin Haematol 2001; 14 (03) 645-669
  • 29 Telenius H, Pelmear AH, Tunnacliffe A. et al. Cytogenetic analysis by chromosome painting using DOP-PCR amplified flow-sorted chromosomes. Genes Chromosomes Cancer 1992; 4 (03) 257-263
  • 30 Senger G, Lüdecke HJ, Horsthemke B, Claussen U. Microdissection of banded human chromosomes. Hum Genet 1990; 84 (06) 507-511
  • 31 Gorczyca W. Cytogenetics, FISH and Molecular Testing in Hematologic Malignancies. 1st ed. Informa UK Ltd.; 2008: 31-108
  • 32 Harrison CJ, Hills RK, Moorman AV. et al. Cytogenetics of childhood acute myeloid leukemia: United Kingdom Medical Research Council Treatment trials AML 10 and 12. J Clin Oncol 2010; 28 (16) 2674-2681
  • 33 de Thé H, Chomienne C, Lanotte M, Degos L, Dejean A. The t(15;17) translocation of acute promyelocytic leukaemia fuses the retinoic acid receptor alpha gene to a novel transcribed locus. Nature 1990; 347 (6293): 558-561
  • 34 Sirulnik A, Melnick A, Zelent A, Licht JD. Molecular pathogenesis of acute promyelocytic leukaemia and APL variants. Best Pract Res Clin Haematol 2003; 16 (03) 387-408
  • 35 Yin CC, Glassman AB, Lin P. et al. Morphologic, cytogenetic, and molecular abnormalities in therapy-related acute promyelocytic leukemia. Am J Clin Pathol 2005; 123 (06) 840-848
  • 36 De Lourdes Chauffaille M, Borri D, Proto-Siqueira R, Moreira ES, Alberto FL. Acute promyelocytic leukemia with t(15;17): frequency of additional clonal chromosome abnormalities and FLT3 mutations. Leuk Lymphoma 2008; 49 (12) 2387-2389
  • 37 Shigesada K, van de Sluis B, Liu PP. Mechanism of leukemogenesis by the inv(16) chimeric gene CBFB/PEBP2B-MHY11. Oncogene 2004; 23 (24) 4297-4307
  • 38 Hernández JM, González MB, Granada I. et al. Detection of inv(16) and t(16;16) by fluorescence in situ hybridization in acute myeloid leukemia M4Eo. Haematologica 2000; 85 (05) 481-485
  • 39 Appelbaum FR, Kopecky KJ, Tallman MS. et al. The clinical spectrum of adult acute myeloid leukaemia associated with core binding factor translocations. Br J Haematol 2006; 135 (02) 165-173
  • 40 Ney Garcia DR, De Souza MT, De Figueiredo AF. et al. Molecular characterization of KMT2A fusion partner genes in 13 cases of pediatric leukemia with complex or cryptic karyotypes. Hematol Oncol 2017; 35 (04) 760-768
  • 41 Rubnitz JE, Raimondi SC, Tong X. et al. Favorable impact of the t(9;11) in childhood acute myeloid leukemia. J Clin Oncol 2002; 20 (09) 2302-2309
  • 42 Schoch C, Schnittger S, Klaus M, Kern W, Hiddemann W, Haferlach T. AML with 11q23/MLL abnormalities as defined by the WHO classification: incidence, partner chromosomes, FAB subtype, age distribution, and prognostic impact in an unselected series of 1897 cytogenetically analyzed AML cases. Blood 2003; 102 (07) 2395-2402
  • 43 Oancea C, Rüster B, Henschler R, Puccetti E, Ruthardt M. The t(6;9) associated DEK/CAN fusion protein targets a population of long-term repopulating hematopoietic stem cells for leukemogenic transformation. Leukemia 2010; 24 (11) 1910-1919
  • 44 Fonatsch C, Gudat H, Lengfelder E. et al. Correlation of cytogenetic findings with clinical features in 18 patients with inv(3)(q21q26) or t(3;3)(q21;q26). Leukemia 1994; 8 (08) 1318-1326
  • 45 Lavallée VP, Gendron P, Lemieux S, D'Angelo G, Hébert J, Sauvageau G. EVI1-rearranged acute myeloid leukemias are characterized by distinct molecular alterations. Blood 2015; 125 (01) 140-143
  • 46 Dastugue N, Lafage-Pochitaloff M, Pagès MP. et al; Groupe Français d'Hematologie Cellulaire. Cytogenetic profile of childhood and adult megakaryoblastic leukemia (M7): a study of the Groupe Français de Cytogénétique Hématologique (GFCH). Blood 2002; 100 (02) 618-626
  • 47 Oki Y, Kantarjian HM, Zhou X. et al. Adult acute megakaryocytic leukemia: an analysis of 37 patients treated at M.D. Anderson Cancer Center. Blood 2006; 107 (03) 880-884
  • 48 Schweitzer J, Zimmermann M, Rasche M. et al. Improved outcome of pediatric patients with acute megakaryoblastic leukemia in the AML-BFM 04 trial. Ann Hematol 2015; 94 (08) 1327-1336
  • 49 O'Brien MM, Cao X, Pounds S. et al. Prognostic features in acute megakaryoblastic leukemia in children without Down syndrome: a report from the AML02 multicenter trial and the Children's Oncology Group Study POG 9421. Leukemia 2013; 27 (03) 731-734
  • 50 Bisio V, Zampini M, Tregnago C. et al. NUP98-fusion transcripts characterize different biological entities within acute myeloid leukemia: a report from the AIEOP-AML group. Leukemia 2017; 31 (04) 974-977
  • 51 de Rooij JD, Hollink IH, Arentsen-Peters ST. et al. NUP98/JARID1A is a novel recurrent abnormality in pediatric acute megakaryoblastic leukemia with a distinct HOX gene expression pattern. Leukemia 2013; 27 (12) 2280-2288
  • 52 Thiollier C, Lopez CK, Gerby B. et al. Characterization of novel genomic alterations and therapeutic approaches using acute megakaryoblastic leukemia xenograft models. J Exp Med 2012; 209 (11) 2017-2031
  • 53 Fenaux P, Preudhomme C, Laï JL, Morel P, Beuscart R, Bauters F. Cytogenetics and their prognostic value in de novo acute myeloid leukaemia: a report on 283 cases. Br J Haematol 1989; 73 (01) 61-67
  • 54 Seifert H, Mohr B, Thiede C. et al; Study Alliance Leukemia (SAL). The prognostic impact of 17p (p53) deletion in 2272 adults with acute myeloid leukemia. Leukemia 2009; 23 (04) 656-663
  • 55 Johansson B, Harrison CJ. Acute myeloid leukemia. In: Heim S, Mitelman F, eds. Cancer Cytogenetics, Chromosomal and Molecular Genetic Aberrations in Tumor Cells. Hoboken, NJ: John Wiley & Sons; 45-139
  • 56 Streubel B, Valent P, Lechner K, Fonatsch C. Amplification of the AML1(CBFA2) gene on ring chromosomes in a patient with acute myeloid leukemia and a constitutional ring chromosome 21. Cancer Genet Cytogenet 2001; 124 (01) 42-46
  • 57 Tang G, DiNardo C, Zhang L. et al. MLL gene amplification in acute myeloid leukemia and myelodysplastic syndromes is associated with characteristic clinicopathological findings and TP53 gene mutation. Hum Pathol 2015; 46 (01) 65-73
  • 58 Albertson DG. Gene amplification in cancer. Trends Genet 2006; 22 (08) 447-455
  • 59 Jain H, Shetty D, Roy Moulik N, Narula G, Subramanian PG, Banavali S. A novel case of intrachromosomal amplification and insertion of RUNX1 on derivative chromosome 2 in pediatric AML. Cancer Genet 2021; 254-255: 65-69
  • 60 Grimwade D, Walker H, Harrison G. et al; Medical Research Council Adult Leukemia Working Party. The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood 2001; 98 (05) 1312-1320
  • 61 Mrózek K. Cytogenetic, molecular genetic, and clinical characteristics of acute myeloid leukemia with a complex karyotype. Semin Oncol 2008; 35 (04) 365-377
  • 62 Breems DA, Van Putten WL, De Greef GE. et al. Monosomal karyotype in acute myeloid leukemia: a better indicator of poor prognosis than a complex karyotype. J Clin Oncol 2008; 26 (29) 4791-4797
  • 63 Shetty D, Talker E, Jain H. Preclinical in-house validation of commercially available fluorescence in situ hybridization probes used in diagnosis of hematological malignancies. Eur J Mol Cancer. 2020; 3 (01) 1-6