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Blood, 15 August 2008, Vol. 112, No. 4, pp. 1042-1047.
Prepublished online as a Blood First Edition Paper on May 16, 2008; DOI 10.1182/blood-2008-01-135970.


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HEMATOPOIESIS AND STEM CELLS

Syndromic thrombocytopenia and predisposition to acute myelogenous leukemia caused by constitutional microdeletions on chromosome 21q

Marwan Shinawi1,*, Ayelet Erez1,*, Deborah L. Shardy2,3, Brendan Lee1,2, Rizwan Naeem2,3, George Weissenberger1,4, A. Craig Chinault1,4, Sau Wai Cheung1,4, and Sharon E. Plon13

Departments of1 Molecular and Human Genetics, 2 Pediatrics, Baylor College of Medicine, Houston, TX; 3 Texas Children's Cancer Center, Baylor College of Medicine and Texas Children's Hospital, Houston, TX; and 4 Medical Genetics Laboratories, Baylor College of Medicine, Houston, TX

Several lines of evidence support the presence of dosage-sensitive genes on chromosome 21 that regulate leukemogenesis and hematopoiesis. We report a detailed clinical and molecular characterization of 3 patients with chronic thrombocytopenia caused by distinct constitutional microdeletions involving chromosomal region 21q22.12. The patients exhibited growth restriction, dysmorphic features, and developmental delays. One patient developed acute myelogenous leukemia (AML) at 6 years of age. All 3 deletions included the RUNX1, CLIC6, DSCR, and KCNE1 genes. Our data provide additional support for the role of RUNX1 haploinsufficiency in megakaryopoiesis and predisposition to AML. The leukemic clone had trisomy 21 resulting from duplication of chromosome 21 containing the RUNX1 deletion. This shows that genes other than RUNX1 must also play a role in AML associated with trisomy 21. We recommend that children with syndromic thrombocytopenia have clinical array-comparative genomic hybridization analysis and appropriate cytogenetic studies to facilitate our ability to provide a definitive diagnosis.


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