Structural Abnormalities Involving Chromosome

Structural lesions involving chromosome 11 band 23 are seen in approximately 14 to 18 percent of childhood107 and 5 percent of adult AML cases and 85 percent of secondary leukemias that occur in patients treated with topoisomerase II inhibitors,123 and rarely in patients with MDS.124 A number of different partners for the balanced 11q23 translocations have been identified, and the most common translocations include t(4;11)(q21;q23), t(9;11)(p22;q23), and t(11;19)(q23;p13). In de novo AML, leukemic blasts containing 11q23 translocations generally have monocytic features and are subclassified as FAB M4 or M5.125 In infant AML, rearrangements of 11q23 occur in 40 to 45 percent of cases and are strongly associated with the M4/M5 subtypes, high WBC counts, and poor prognosis.126'127 However, recent studies indicate that MLL/11q23 rearrangements lacked prognostic significance in infant AML,128,129 whereas the presence of t(9;11) conferred a favorable outcome. In adult cases of de novo AML 11q23 rearrangements have been reported in 23 percent of cases of M4 and M5 subtypes but were not associated with specific clinical or prognostic factors.130 11q23 rearrangements have also been observed in biphenotypic leukemias.

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