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+X solely in myeloid malignancies

Written2017-07Adriana Zamecnikova
Kuwait Cancer Control Center, Department of Hematology, Laboratory of Cancer Genetics, Kuwait;

Abstract Review on +X solely in myeloid malignancies, with data on clinics.

Keywords Chromosome X; chromosome gains; acute myeloid leukemia; chronic myeloproliferative disorders; gain of sex chromosome.

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ICD-Topo C420,C421,C424
ICD-Morpho 9975/3 Chronic myelogenous leukaemia, BCR-ABL1 positive; Myeloproliferative neoplasm, unclassifiable; Myelodysplastic/myeloproliferative neoplasm, unclassifiable
ICD-Morpho 9963/3 Chronic neutrophilic leukaemia
ICD-Morpho 9989/3 Myelodysplastic syndrome, unclassifiable
ICD-Morpho 9920/3 Therapy-related myeloid neoplasms
ICD-Morpho 9861/3 AML with mutated NPM1; AML with mutated CEBPA; Acute myeloid leukaemia, NOS
ICD-Morpho 9872/3 AML with minimal differentiation; Myeloid sarcoma
ICD-Morpho 9801/3 Acute undifferentiated leukaemia
ICD-Morpho 9874/3 AML with maturation
ICD-Morpho 9891/3 Acute monoblastic and monocytic leukaemia
ICD-Morpho 9808/3 Mixed phenotype acute leukaemia, B/myeloid, NOS 152
Atlas_Id 1221
  Figure 1. Fluorescence in situ hybridization with centromeric CEP X/Y probe (Abbott Molecular, Vysis, US) showing 3 copies of chromosome X (red signal) in metaphase and interphase cells. Partial karyotype showing an extra copy of chromosome X (inset).

Clinics and Pathology

Disease Chronic myeloproliferative disorders and acute myeloid leukemia
Epidemiology 9 patients diagnosed with myeloid malignancies (6 males and 3 females) aged 27 to 73 years (median 50 years); among them there 5 acute myeloid leukemia (AML) cases, not associated with a particular leukemia subtype: 1 acute monoblastic leukemia (AML-M5) (Akiyoshi et al., 1991), 1 acute myeloblastic leukemia with maturation (AML-M2) (Wan et al., 2002), 1 acute myeloblastic leukemia with minimal differentiation (AML-M0) (Dicker et al., 2007) and 2 cases of childhood AML (Raimondi et al 1999). 4 patients had various disorders: 1 secondary myelodysplastic syndrome (MDS) developed after chemotherapy for Hodgkin's disease (Pedersen-Bjergaard et al 1997), 1 chronic neutrophilic leukemia (Yamamoto et al., 2002), 1 bilineage or biphenotypic leukemia (Tsutsumi et al., 2005) and 1 chronic myeloid leukemia patient who developed trisomy 8 /trisomy X abnormalities in Philadelphia-negative cells during imatinib mesylate treatment (Kim et al., 2008) (Table 1). Extra chromosome X was also reported in 2 patients receiving high dose chemotherapy who developed blood cytopenias as well as subtle to mild dysplastic features after autologous stem cell transplantation, which were not classifiable as MDS (Martinez-Climent et al., 2000)
Table 1. Clinical and karyotypic data of patients with myeloid malignancies and +X solely.
1FAcute monoblastic leukemia47,XX,+X
2M/27Refractory anemia
previous chemotherapy for Hodgkin's disease
3MAcute myeloid leukemia47,XY,+X
4MAcute myeloid leukemia47,XY,+X
5F/58Nonneoplastic hematologic disorder/lesion
chemotherapy for adenocarcinoma
47,XX,+X      transient
6F/43Nonneoplastic hematologic disorder/lesion
chemotherapy for  adenocarcinoma
47,XX,+X      transient
7M/73Chronic neutrophilic leukemia47,XY,+X       at progression
8F/44Acute myeloblastic leukemia with maturation 47,XX,+X
9M/67Bilineage or biphenotypic leukemia 47,XY,+X
10MAcute myeloblastic leukemia with minimal differentiation55,XY,+X,+4,+5,+8,+10,+13,+14,+17,+18/47,XY,+X
11F/50Chronic myeloid leukemia47,XX,+8
47,XX,+X transient

Abbreviations: M, male; F, female.
1. Akiyoshi et al, 1991; 2. Pedersen-Bjergaard et al., 1997; 3. Raimondi et al., 1999; 4. Raimondi et al., 1999; 5. Martinez-Climent et al., 2000; 6. Martinez-Climent et al., 2000; 7. Yamamoto et al., 2002; 8. Wan et al., 2002; 9. Tsutsumi et al., 2005; 10. Dicker et al., 2007; 11. Kim et al., 2008.
Prognosis Unknown, due to few number of patients and limited clinical data; the case with a secondary MDS, which developed 4 months after autologous stem cell transplantation for Hodgkin's lymphoma died 2 months after the onset of MDS (Pedersen-Bjergaard et al.,1997). The 44-year-old woman with acute myeloblastic leukemia with maturation and abnormal eosinophils in the bone marrow developed diffuse alveolar damage and pulmonary hemorrhage while on induction chemotherapy and died 9 days after institution of chemetherapy (Wan et al., 2002). The 73-year-old man with chronic neutrophilic leukemia had normal karyotype at diagnosis, but after therapy with hydroxyurea for 7 months, the disease progressed to a blast crisis accompanied by appearance of an extra X chromosome, suggesting its role in the progression from chronic phase to the blast crisis of CNL (Yamamoto et al 2002). The 50-years old female with chronic myeloid leukemia developed only transient trisomy X in Philadelphia-negative cells during imatinib mesylate treatment (Kim et al., 2008).


The observation of an extra chromosome X may indicate constitutional or acquired anomaly, therefore it should be carefully interpreted when an extra X chromosome is the only abnormality or present in a form of chromosomal mosaicism in patients with hematologic malignancy.

Result of the chromosomal anomaly

Fusion Protein
Oncogenesis An extra X chromosome as a sole acquired abnormality has been reported in patients with several hematologic malignancies especially in childhood acute lymphoblastic leukemia and lymphomas. While whole chromosome gains are frequent cytogenetic aberrations in myeloid malignancies, gain of X chromosome as the sole anomaly has been only occasionally observed. Its occurrence in both chronic and acute myeloid malignancies suggest involvement of multiple hematopoietic lineages. The presence of an additional copy of chromosome X might result in increased gene dosage and altered expression of many genes simultaneously, some of which could promote oncogenesis while others could perform inhibitory roles. The oncogenic mechanisms underlying remain largely elusive and it is unclear if gain of X chromosome directly contributes to malignant transformation or aneuploidy-induced transcriptional changes might only allow direct acquisition of cancer-driving mutations.


Genotypic and cytogenetic study of acute myelocytic leukemia and chronic myelocytic leukemia in blast crisis: specific delta rearrangement pattern does not involve J delta gene locus
Akiyoshi TT, Kimura N, Uike N, Kozuru M, Tamura K, Takihara Y, Hisano S, Nishimura J, Kikuchi M
Leuk Res 1991;15(8):683-91
PMID 1654480
Trisomy 13 is strongly associated with AML1/RUNX1 mutations and increased FLT3 expression in acute myeloid leukemia
Dicker F, Haferlach C, Kern W, Haferlach T, Schnittger S
Blood 2007 Aug 15;110(4):1308-16
PMID 17485549
Transient trisomy 8 abnormality in Philadelphia-negative cells during imatinib mesylate treatment of chronic myelogenous leukemia
Kim M, Lee S, Jung CK, Lim J, Cho SG, Kim DW, Kim Y, Han K, Min WS, Kim CC
Int J Lab Hematol 2008 Dec;30(6):508-12
PMID 18983302
Chromosomal abnormalities in women with breast cancer after autologous stem cell transplantation are infrequent and may not predict development of therapy-related leukemia or myelodysplastic syndrome
Martínez-Climent JA, Comes AM, Vizcarra E, Benet I, Arbona C, Prósper F, Solano C, García Clavel B, Marugán I, Lluch A, García-Conde J
Bone Marrow Transplant 2000 Jun;25(11):1203-8
PMID 10849534
High risk of therapy-related leukemia after BEAM chemotherapy and autologous stem cell transplantation for previously treated lymphomas is mainly related to primary chemotherapy and not to the BEAM-transplantation procedure
Pedersen-Bjergaard J, Pedersen M, Myhre J, Geisler C
Leukemia 1997 Oct;11(10):1654-60
PMID 9324285
Chromosomal abnormalities in 478 children with acute myeloid leukemia: clinical characteristics and treatment outcome in a cooperative pediatric oncology group study-POG 8821
Raimondi SC, Chang MN, Ravindranath Y, Behm FG, Gresik MV, Steuber CP, Weinstein HJ, Carroll AJ
Blood 1999 Dec 1;94(11):3707-16
PMID 10572083
Acute biphenotypic leukemia and an acquired X chromosome
Tsutsumi Y, Tanaka J, Minami H, Musashi M, Fukushima A, Ehira N, Kanamori H, Yamato H, Sasaki J, Funaki C, Hasegawa S, Obara S, Ogura N, Asaka M, Imamura M, Masauzi N
Cancer Genet Cytogenet 2005 Feb;157(1):94-5
PMID 15676158
Fatal diffuse alveolar damage complicating acute myeloid leukemia with abnormal eosinophils and trisomy X
Wan TS, Yip SF, Yeung YM, Chan LC, Ma SK
Ann Hematol 2002 Mar;81(3):167-9
PMID 11904745
Acquired gain of an X chromosome as the sole abnormality in the blast crisis of chronic neutrophilic leukemia
Yamamoto K, Nagata K, Kida A, Hamaguchi H
Cancer Genet Cytogenet 2002 Apr 1;134(1):84-7
PMID 11996803


This paper should be referenced as such :
Adriana Zamecnikova
+X solely in myeloid malignancies
Atlas Genet Cytogenet Oncol Haematol. 2018;22(9):379-381.
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External links

arrayMap (UZH-SIB Zurich)Morph ( 9975/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9963/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9989/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9920/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9861/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9872/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9801/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9874/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9891/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
arrayMap (UZH-SIB Zurich)Morph ( 9808/3) -   [auto + random 100 samples .. if exist ]   [tabulated segments]
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