ASSOCIATION BETWEEN LEUKEMIC EVOLUTION AND UNCOMMON CHROMOSOMAL ALTERATIONS IN PEDIATRIC MYELODYSPLASTIC SYNDROME

Main Article Content

Viviane Lamim Lovatel https://orcid.org/0000-0001-8493-5855
Beatriz Ferreira da Silva https://orcid.org/0000-0003-4375-9300
Eliane Ferreira Rodrigues https://orcid.org/0000-0003-0419-567X
Maria Luiza Rocha da Rosa Borges https://orcid.org/0000-0002-9910-578X
Rita de Cássia Barbosa Tavares https://orcid.org/0000-0002-9050-7918
Ana Paula Silva Bueno https://orcid.org/0000-0003-0167-2258
Elaine Sobral da Costa https://orcid.org/0000-0002-5340-5816
Terezinha de Jesus Marques https://orcid.org/0000-0001-6728-2813
Teresa de Souza Fernandez

Keywords

Pediatric myelodysplastic syndrome, uncommon chromosomal abnormalities, leukemia evolution, prognosis

Abstract

Background and objective: Pediatric myelodysplastic syndrome (pMDS) is a group of rare clonal neoplasms with a difficult diagnosis and risk of progression to acute myeloid leukemia (AML). The early stratification in risk groups is essential to choosing the treatment and indication for allogeneic hematopoietic stem cell transplantation (HSCT). According to the Revised International Prognostic Scoring System, cytogenetic analysis has demonstrated an essential role in diagnosis and prognosis. In pMDS, abnormal karyotypes are present in 30-50% of the cases.  Monosomy 7 is the most common chromosomal alteration associated with poor prognosis. However, the rarity of specific cytogenetic alterations makes its prognosis uncertain. Thus, this study aimed to describe uncommon cytogenetic alterations in a cohort of 200 pMDS patients and their association with evolution to AML. Methods: The cytogenetic analysis was performed in 200 pMDS patients by G-banding and fluorescence in situ hybridization between 2000 to 2022. Results: Rare chromosome alterations were observed in 7.5% (15/200) of the cases. These chromosome alterations were divided into four cytogenetic groups: hyperdiploidy, biclonal chromosomal alterations, translocations, and uncommon deletions, which represented 33.3%, 33.3%, 20%, and 13.3%, respectively. Most of these patients (10/15) were classified with advanced MDS (MDS-EB and MDS/AML) and the initial subtype was present in five patients (RCC). The leukemic evolution was observed in 66.66% (10/15) of the patients. Most patients had poor clinical outcomes and they were indicated for HSCT.  Conclusion: The study of uncommon cytogenetic alterations in pMDS is important to improve the prognosis and guide early indication of HSCT. 


Keywords: Pediatric MDS; Leukemic evolution; rare chromosomal altwerations; HSCT, Children

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