Because of a lack of specific clonality markers, information on lineage involvement and cell of origin of acute myeloid leukemia with normal karyotype (AML-NK), is missing. Because Nucleophosmin (NPM) gene is frequently mutated in AML-NK and causes aberrant NPM cytoplasmic localization (NPMc ؉ ), it was used as an AML lineage clonality marker. Clonal NPM exon 12 mutations were detected in myeloid, monocytic, erythroid, and megakaryocytic cells but not in fibroblasts or endothelia that were lasermicrodissected from 3 patients with NPMc ؉ AML. Aberrant cytoplasmic expression of mutated NPM proteins was identified with anti-NPM antibodies in 2 or more myeloid hemopoietic cell lineages in 99 (61.5%) of 161 of NPMc ؉ AML paraffin-embedded bone marrow biopsies; lymphoid involvement was excluded in 3 investigated cases. These findings suggest that NPMc ؉ AML derives from either a common myeloid or earlier progenitor.
IntroductionClonal cell lineage involvement in myelodysplastic syndrome and acute myeloid leukemia (AML) carrying recurrent genetic abnormalities can be successfully investigated by a number of techniques, including cytogenetics, fluorescence in situ hybridization (FISH), FISH combined with immunophenotyping, and polymerase chain reaction (PCR) on purified cell populations, which are all able to detect leukemia-specific molecular alterations. 1-7 Unfortunately, no specific genetic markers are as yet available for a significant proportion of AML. Under these circumstances, cell lineage clonality can be investigated by analysis of X-chromosome inactivation patterns, 8 but this technique has not been applied widely to AML. Thus, no or scarce information is available on cell lineage involvement or cell of origin in most AMLs, especially those with normal karyotype (AML-NK), 9 which lack specific clonality markers and account for 40% to 50% of de novo adult AML. 10 All genetically poorly defined AMLs, including AML-NK, are now included into the category of "acute myeloid leukemia not otherwise characterized" of the World Health Organization (WHO) classification. 11 This large, poorly characterized subgroup of AML is currently defined according to criteria of the French-AmericanBritish (FAB) classification 12 (with some modification), which is based on morphologic and cytochemical features of the leukemic cells and degree of maturation. Given its frequency and extreme heterogeneity, AML not otherwise characterized clearly needs to be defined better.We recently identified mutations of the NPM gene exon 12 as the most common and specific genetic lesion associated with AML-NK, 13 being observed in 50% to 60% of cases, as confirmed to date in more than 3500 patients with AML. [14][15][16][17][18][19] At the NPM protein C-terminus, these mutations modify critical tryptophan(s) and create a new nuclear export signal (NES) motif, which act together to aberrantly localize NPM leukemic mutants in the cytoplasm 20,21 -hence the term NPMc ϩ (cytoplasmic-positive) AML. 13 As the NPM mutant protein dislocates the NPM wild-t...