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Acute Promyelocytic Leukemia (APL) is characterized by Promyelocytic Leukemia-Retinoic Acid Receptor Alpha (PML-RARA) fusion transcripts. However, in some cases, Retinoic Acid Receptor Alpha (RARA) can fuse with other genes.
In a Letter to the Editor of Blood, Cheng et al., from the Chinese University of Hong Kong, Hong Kong, report a patient with a variant APL because of a novel Fibronectin Type III Domain Containing 3B-Retinoic Acid Receptor Alpha (FNDC3B-RARA) fusion. Cheng et al. also report on the molecular characterization of the FNDC3B-RARA fusion and its implication in granulocytic differentiation.
Patient (male, 36 years) presented with symptoms including fatigue, dyspnea, and easy bruising. After complete blood count and Bone Marrow (BM) examination, the patient was diagnosed with APL and immediately administered All-Trans Retinoic Acid (ATRA; 45mg/m2/day). Patient developed Differentiation Syndrome (DS) on day 4 and was then administered 7 + 3 induction chemotherapy and achieved morphological complete remission at day 30. The BM sample collected at diagnosis was analyzed molecularly.
FNDC3B-RARA fusion was characterized molecularly.
The authors noted that FNDC3B-RARA fusion is the “13th RARA fusion gene identified” with opposite ATRA responses within the t(3;17) APL subtype.
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