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PML/RARα(RARA) Translocation, Dual Fusion

Applications
haematology
Catalogue Numbers
LPH 023 (10 tests)
LPH 023-S (5 tests)

The fusion gene PML/RARA is created by the t(15;17)(q24.1;q21.2) translocation, found in 98% of AML M3 acute hypergranular promyelocytic leukaemia and 9% of AML overall1,2,3.

Breakpoints in the PML gene vary between intron 3 and exon 7a, which is in contrast to the RARA breakpoint, which remains constant in intron 2. Variant translocations include partner breakpoints in 11q23, 5q32 and 11q13. The presence of three-way translocations indicate that the critical event occurs on the der(15), which always receives the distal end of chromosome 17.

The PML protein is a transcription factor and RARA encodes a nuclear receptor. The fusion protein generated, PML-RARA, is a chimaeric transcription factor that operates as a dominant negative form of RARA and results in cells that are blocked at the promyelocytic stage of differentiation and then proliferate. Gain of function mutation allows repression of multiple genes and recruitment of DNA methyltransferases to promoters, allowing prolonged suppression. PML-RARA also activates components of the WNT signalling pathway, promoting stem cell renewal.

Immediate treatment of PML/RARA positive patients is critical as intravascular coagulation causes early death in 10-40% of cases2. Terminal differentiation is induced by the use of all-trans-retinoic-acid (ATRA), which reactivates the RARA gene and degrades the PML-RARA fusion product and 80-90% of treated patients achieve complete remission1,2,4. Despite the efficacy of ATRA, the death rate remains around 15-20%, but 70% of patients will achieve 3 year survival2. Additional abnormalities found with PML/RARA translocations include trisomy 8, seen in one third of cases, del(7q) and del(9q)2.

References

1. Licht, Sternberg, The Molecular Pathway of AML. ASH Education Book 2005;137-42

2. Huret and Chomienne. t(15;17)(q24;q21). Atlas Genet Cytogenet Oncol Haematol 1998;2(3):329-34

3. Heim and Mitelman, Willey-Liss, Inc. 1995

4. Greaves, BMJ 2002;324(7332):283-7

Microscope Images

PML RARA (RARA) Translocation Dual Fusion magnified
Area of Interest*
AML

Disclaimer

This product is intended to be used on Carnoy’s solution (3:1 methanol/acetic acid) fixed haematological samples.

*Disease information supported by the literature and is not a reflection of the intended purpose of this product.